Effectiveness of a Guideline for Venous Thromboembolism Prophylaxis in Elderly Post–Acute Care Patients

Sellier, Élodie

doi:10.1001/archinte.166.19.2065

Cited by 33 publications

(27 citation statements)

References 32 publications

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“…22 We should note that the isolated increase in use of compression stockings was also seen in studies following the implementation of protocols to improve thromboprophylaxis performed elsewhere. 25,35 Even taking in consideration the degree of anti-thrombotic protection provided by graduated elastic compression stockings, 36,37 the results of implementing the protocol still leave much to be desired, since this method was often used for too short a period when compared to patients' total length of stay. The absence of more effective results from implementing the DVT protocol at the two HSL Admission Units may be connected to the lack of continuous advertisement of prophylaxis guidelines, though at first HSL's Clinical Staff was firmly mobilized, and a communications campaign publicized the guidelines.…”

Section: Discussionmentioning

confidence: 99%

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

Maffei

Sato

Filho

et al. 2009

Rev. Assoc. Med. Bras.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Maffei

Sato

Filho

et al. 2009

Rev. Assoc. Med. Bras.

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“…Despite the availability of evidence-based prevention guidelines for VTE, prophylaxis of VTE has been underused or often inappropriately used for all patients at risk (Cohen et al, 2008;Jaffer et al, 2008;Sellier et al, 2006;Yu et al, 2007). Very few studies have looked at VTE prevention focusing on the older population.…”

Section: Vte Prevention and Management In The Older Adult Populationmentioning

confidence: 99%

“…Very few studies have looked at VTE prevention focusing on the older population. A recent multicenter study (Sellier et al, 2006) was conducted to determine whether a multifaceted intervention, including pharmacological and mechanical prophylaxis, decreased the incidence of DVT in elderly post-acute care patients. The results from Sellier et al's (2006) study showed that DVT occurred in 12% of older adults during the preintervention phase and 8% during the postintervention phase (p = 0.002).…”

Section: Vte Prevention and Management In The Older Adult Populationmentioning

confidence: 99%

“…Of note, there was a significant decrease in calf DVT (7% in preintervention versus 3.6% in postintervention). Sellier et al (2006) examined the appropriateness of graduated compression stockings in older adults; almost 50% of gradukEYPOinTS Lee, J.-A., & Zierler, B.K. (2010).…”

Section: Vte Prevention and Management In The Older Adult Populationmentioning

confidence: 99%

“…VTE occurs in approximately 100 people per 100,000 annually in the United States and increases exponentially, with 500 cases per 100,000 people at age 80 and older (White, 2003). Increasing age is identified as an independent risk factor for VTE, in addition to hospitalization (Sellier et al, 2006). The hospitalized older adult population is increasing along with the overall aging of the U.S. population (Kucher et al, 2005).…”

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confidence: 99%

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Prevention and Clinical Outcomes in Older Inpatients with Suspected Venous Thromboembolism

Lee¹,

Zierler²

2010

J Gerontol Nurs

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Venous thromboembolism (VTE) is one of the most common preventable disorders among hospital inpatients. Advancing age is a major risk factor for VTE. The purpose of this study was to describe and compare prevention practices and clinical outcomes in older (age 65 and older) versus younger (ages 18 to 64) hospitalized patients at risk for or diagnosed with VTE. Medical charts of 210 older and 450 younger inpatients undergoing diagnostic tests to rule out VTE were reviewed at an academic medical center. Acute VTE was diagnosed in 17.1% of older and 22.7% of younger inpatients. Pharmacological prophylaxis was used in 70% of eligible older and 57% of eligible younger inpatients. Nearly one quarter of eligible older inpatients did not receive any VTE prevention measures. The 3-month mortality was higher in older inpatients (13.9%) compared with younger inpatients (9.8%) with VTE, despite the lower rate of VTE in older inpatients. Prevention measures for VTE were underused in both older and younger inpatients. Prevention and Clinical Outcomes in Older Inpatients with Suspected Venous ThromboembolismJung-Ah Lee, PhD, RN; and Brenda K. Zierler, PhD, RN 40Copyright © SLACK Incorporated ule on VTE prophylaxis, and evaluated the effectiveness of the tools on improving clinical and system outcomes for patients at risk for or diagnosed with VTE. The VTE Safety Toolkit consists of VTE prevention guidelines based on ACCP recommendations (Geerts et al., 2008), DVT/PE diagnostic algorithms, and treatment guidelines for acute VTE (Zierler et al., 2008). The VTE Safety Toolkit has been disseminated nationally via the AHRQ's patient safety website at http://www.ahrq.gov/qual/pips/ grants.htm. The methods of the parent study were described in detail elsewhere (Lee & Zierler, in press).During the study period from October 1, 2005 to March 31, 2006, data were reviewed on patient demographics, risk factors for VTE, use of VTE prophylaxis, and treatment of VTE for patients age 18 and older who were referred to undergo a diagnostic test to rule out VTE at an academic medical center. This study used retrospective medical chart reviews to describe the current practices on VTE prevention, treatment, and clinical outcomes in patients with suspected VTE, and particularly focused on older inpatients.The radiology electronic database at the academic medical center was used to identify patients with suspected VTE. All patients (age 18 and older) who were referred for lower extremity venous duplex ultrasonography to rule out DVT, and ventilation and perfusion scanning (V/Q scan) or computed tomographic angiography (spiral CT) to rule out PE were included in this study. Retrospective reviews of medical records for 660 consecutive hospitalized patients (age 18 and older) referred to the vascular or radiology laboratories during the study period were conducted. All inpatients suspected for VTE were classified by different age categories: older (age 65 and older) versus younger (ages 18 to 64), as well as four age categories: ages 18 to 40, 4...

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Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism

Kahn

Morrison

Cohen

et al. 2013

Cochrane Database of Systematic Reviews

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Effectiveness of a Guideline for Venous Thromboembolism Prophylaxis in Elderly Post–Acute Care Patients

Abstract: A multifaceted intervention addressing venous thromboembolism prophylaxis in post-acute care patients can be followed by a significant decrease in the rate of any DVT in elderly patients. More active interventions are needed to enforce compliance with evidence-based guidelines.

Cited by 33 publications

References 32 publications

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

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

Prevention and Clinical Outcomes in Older Inpatients with Suspected Venous Thromboembolism

Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism

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