Thromboprophylaxis after major orthopedic surgery: Improving compliance with clinical practice guidelines. (January 2016)

• Record Type: Journal Article
• Authors: Bautista, Maria; Llinás, Adolfo; Bonilla, Guillermo; Mieth, Klaus; Diaz, Mario; Rodriguez, Fernanda
• Is Part Of: Thrombosis research. Volume 137(2016)
• Page Start: 113
• Page End: 118
• Publication Date: 2016-01
• Subjects: Arthroplasty -- Replacement -- Prevention & control -- Venous thromboembolism -- Guideline adherence -- Quality indicators -- Health care; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2015.10.020
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Identifying risk factors and strategies for the prevention of deep venous thromboembolism in major orthopedic surgery has allowed the development of Clinical Practice Guidelines (CPGs). Currently, there is a gap between clinical practice and the implementation of the recommendations of CPGs. The purpose of this paper is to report the impact of the implementation of improvement strategies on adherence to venous thromboembolism (VTE) prophylaxis guidelines. Materials and methods: We defined 3 quality indicators to assess the adequate use of thromboprophylaxis according to CPGs. We obtained a baseline measurement and identified several barriers for adherence. Six improvement strategies to promote adherence to CPGs were designed and applied. A systematic monitoring of these indicators was performed in real time and a description of the data was completed for patients undergoing primary joint replacement of the hip, knee and shoulder, during February 2012 and August 2014. Results: Data from 773 patients were obtained. In the first trimester, the average of adherence was: 98.3% for medical order in the post-operative note, 60.3% for opportune administration and 67% for adherence to therapy at home. In the trimester, the rates of adherence were 100%, 95.7% and 100% respectively. Conclusions: Combined strategies for improvement of adherence to VTE prophylaxis is associated with higher compliance with clinical practice guidelines. Highlights: Several barriers for adherence were identified and addressed. Goal of 100% of compliance was achieved. Adherence rates in this study are higher to previous reports in the literature. Quality improvement strategies are required to maintain high rates of adherence.