Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos

Abstract

IntroductIon.Effective strategies for prophylaxis of venous thromboembolism (VTE) are widely available, but remain underused, especially in Brazil. objectIve. The objective of this study was to assess the effect of implementing a guideline for VTE prophylaxis for surgical patients on the behavior of the health care staff regarding prophylaxis for patients submitted to orthopedic or abdominal surgery. Methods. This was a retrospective pre-intervention/post-intervention study. The charts of 150 patients before (BGI) and 150 ones after guideline implementation (AGI) were selected at random from all patients over the age of 40 admitted for major abdominal or orthopedic surgery. Data registered: demographic data, reference to VTE risk factors in chart, VTE prophylaxis prescription, VTE diagnosis during hospitalization. results. There was no difference between BGI and AGI in terms of demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of BGI versus AGI prophylaxis before surgery was: pharmacological prophylaxis (PP), 6% versus 9%; graduated compression stockings (GCS), 4% versus 3%; intermittent pneumatic compression (IPC), 2% versus 3%. After surgery: PP, 53% versus 53%; GCS, 23% versus 40% (p < 0.05); IPC, 26% versus 32%. Including all patients, prophylaxis was prescribed for 60.5% of patients BGI and 66.5% AGI, but it was considered adequate for 34% of patients BGI and 32% AGI. conclusIon. Adoption of the guideline, despite the greater concern with prophylaxis, as expressed by higher rates of prescription of GCS, provided only minimal quality improvements, indicating that other active and continuous interventions are needed to increase compliance.

A clinical decision support system for venous thromboembolism prophylaxis at a general hospital in a middle-income country

“…In Brazil, studies conducted in the cities of São Paulo ( 21 ) and Salvador ( 22 ) showed that the distribution of written guidelines for physicians was not effective in increasing adherence to prophylactic measures. A meta-analysis that evaluated the effectiveness of different strategies to increase adherence to prophylactic measures for VTE also showed that passive measures, such as the distribution of guidelines, were ineffective.…”

“…Our findings suggest that other hospitals in Brazil should consider implementing a CDSS to increase the use of VTE prophylaxis, given that studies evaluating the use of non-computerized protocols have shown that such protocols provide no benefit. ( 21 , 22 ) …”

Freqüência da profilaxia mecânica para trombose venosa profunda em pacientes internados em uma unidade de emergência de Maceió

“…Já Maffei et al 26 observou o efeito da implementação de uma diretriz para a profilaxia do tromboembolismo venoso em um hospital privado, abrangendo médicos, enfermeiros e fisioterapeutas; embora tenha aumentado a preocupação com a profilaxia, aumentou pouco sua qualidade e tempo de utilização, sendo necessárias outras intervenções mais ativas e contínuas.…”

Tromboprofilaxia: recomendações médicas e programas hospitalares

“…Outro estudo retrospectivo também avaliou a implantação das diretrizes nacionais em pacientes cirúrgicos, em hospital universitário 76 . A divulgação do projeto envolveu a adoção de algoritmo, reuniões de consenso, divulgação em reunião de equipe de saúde e carta de apresentação da administração hospitalar.…”

“…A divulgação do projeto envolveu a adoção de algoritmo, reuniões de consenso, divulgação em reunião de equipe de saúde e carta de apresentação da administração hospitalar. A aderência em relação à tromboprofilaxia foi inadequada, embora meias elásticas compressivas tenham sido mais prescritas 76 .…”