Multidisciplinary, patient-centred approach to improving compliance with venous thromboembolism (VTE) prophylaxis in a district general hospital

Abstract

Hospital-acquired venous thromboembolism (VTE) accounts for an estimated 25 000 preventable deaths per annum in the UK and is associated with significant healthcare costs. The National Institute for Health and Care Excellence guidelines on the prevention of VTE in hospitalised patients highlight the clinical and cost-effectiveness of VTE prevention strategies. A multidisciplinary quality improvement team (MD QIT) based in a district general hospital sought to improve compliance with VTE prophylaxis prescription to greater than 85% of patients within a 3-month time frame. Quality improvement methodology was adopted over three cycles of the project. Interventions included the introduction of a ‘VTE sticker’ to prompt risk assessment; educational material for medical staff and allied healthcare professionals; and patient information raising the awareness of the importance of VTE prophylaxis. Implementation of these measures resulted in significant and sustained improvements in rates of risk assessment within 24 hours of admission to hospital from 51% compliance to 94% compliance after cycle 2 of the project. Improvements were also observed in medication dose adjustment for the patient weight from 69% to 100% compliance. Dose adjustments for renal function showed similar trends with compliance with guidelines improving from 80% to 100%. These results were then replicated in a different clinical environment. In conclusion, this project exemplifies the benefits of MD QITs in terms of producing sustainable and replicable improvements in clinical practice and in relation to meeting approved standards of care for VTE risk assessment and prescription. It has been demonstrated that the use of educational material in combination with a standardised risk assessment tool, the ‘VTE sticker’, significantly improved clinical practice in the context of a general medical environment.

A quality improvement approach to improving recognition of Māori tamariki (children) and assessing barriers to culturally responsive care in a paediatric ward setting

“…Similar to the studies by Kaufman et al (2020) and Nana et al (2020), the sticker prompts appeared to increase clinicians' rates of enquiry about the sticker subject with the patient. A significant theme was the idea that the stickers prompted clinicians to spend more time on conversations around patients' cultural needs.…”

“…For example, Kaufman et al (2020) utilised a sticker prompt as part of a package to increase midwife antenatal vaccine discussions and improve maternal and childhood vaccine uptake. Simple clinical reminders have been shown to increase physician awareness and compliance with best practice in areas such as venous thromboembolism prophylaxis (Nana et al, 2020), antimicrobial prophylaxis (Hill et al, 2021) and managing dehydration in the elderly (Bhatti et al, 2017). The fact that a visual prompt was effective in this diverse range of health contexts suggested that it might be an effective way to remind practitioners about patient ethnicity in situ and also to facilitate broader discussions about culturally responsive care given in the paediatric ward environment.…”

Adherence to NICE guidelines for Venous Thromboembolism (VTE) Prophylaxis in Surgical Patients – Examining the Impact of Electronic Prescribing and Medicines Administration (EPMA)

“…The expectations are that the NICE guidelines should focus on all hospitalised patients and provide patientcentred care across different healthcare specialities [14]. Therefore, adherence to NICE guidelines should allow enhanced VTE prophylaxis administration and reduced DVT incidences [15].…”

Electronic prescribing systems as tools to improve patient care: a learning health systems approach to increase guideline concordant prescribing for venous thromboembolism prevention

“…This study highlights the benefit of a paperless system, where real-time prescribing prompts can be given which account for clinical information, as opposed to static prompts, and where analysis includes all records overs a prolonged period. Some quality improvement papers in this field are based on standard audit procedures, where only a proportion of records are reviewed over a short period, leading to a significant risk of bias and making it unclear whether improvements were maintained [ 27 , 28 ].…”