Preventing venous thromboembolism at a district hospital: a quality improvement study

Abstract

Background: Pulmonary embolism (PE) is the most common preventable cause of hospital deaths, and almost all hospitalised patients have at least one risk factor for venous thromboembolism (VTE). Despite the availability of highly effective thromboprophylaxis in preventing VTE, numerous studies worldwide have demonstrated its under-utilisation. The aim of this study was to review and improve the utilisation of thromboprophylaxis in the prevention of VTE in hospitalised patients at Oudtshoorn district hospital, and to make recommendations to the Western Cape Department of Health on how to improve the quality of care for patients at risk for VTE at district hospitals. Method: A quality improvement cycle (QIC). Retrospective analysis of files of adult patients admitted to the male and female wards at Oudtshoorn district hospital was performed prior to and after a five-month intervention phase. The target standards for the QIC were: (1) availability of a written hospital policy on VTE prevention; (2) every adult admission should have a formal VTE risk assessment documented; (3) every adult admission who is at risk for VTE should receive thromboprophylaxis. Results: Some 38% of adult patients admitted to Oudtshoorn Hospital, excluding the maternity ward, were at risk of developing VTE. There was no written hospital policy on VTE prevention. This was developed and made available during the intervention. In the pre-intervention group there were no patients who had a documented VTE risk assessment. The post intervention group showed a considerable increase with 45.2% having had a completed VTE risk assessment on admission (p < 0.001). In the pre-intervention group only 4.6% of patients who were at risk of VTE received thromboprophylaxis. There was a statistically significant difference in the number of patients at risk who received thromboprophylaxis in the post-intervention group where 36% of these patients received thromboprophylaxis (p < 0.001). Conclusions:The study identified a major shortcoming in the prevention of VTE in those patients at risk who were admitted to Oudtshoorn district hospital. An intervention as part of a quality improvement cycle has been able to demonstrate a significant improvement in the detection of patients who are at risk of VTE and a subsequent improvement in appropriate thromboprophylaxis. A number of barriers to their implementation have been identified and need to be addressed. This QIC may in time be of value to assist other district hospitals in addressing the issue of VTE prevention.

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

“…Numerous interventions have been proposed to improve VTE prophylaxis prescription, such as electronic alert systems, an opt-out thromboprophylaxis policy, performance evaluation and feedback, as well as practitioner education. [13][14][15][16][17] Although electronic prescription alerts and performance reviews are not be feasible in our setting, the inclusion of a risk assessment sheet on the inpatient prescription charts and providing continuous practitioner education are interventions that should be considered for improving VTE prophylaxis prescription. With such a high percentage of patients at risk, an opt-out policy of thromboprophylaxis prescription should also be considered.…”

Prevention of Venous Thromboembolism in General Surgery at Gabriel Tour&#233; University Hospital in Mali

“…In Togo, it was less than 07 days [14]. Compliance with the recommendations in our contexts seems to come up against several obstacles including: the high cost and the unavailability of treatment resources, the lack of a thromboprophylaxis practice protocol, the difficulties in identifying patients at risk, insufficient knowledge of the recommendations in this area [10] [13] [14] [16]. A South African study evaluating the impact of communication for improving the practices of health professionals has shown that it allows a significant increase in the frequency of thromboprophylaxis in patients at risk, which increased from 4.6% to 36% [16].…”

“…Compliance with the recommendations in our contexts seems to come up against several obstacles including: the high cost and the unavailability of treatment resources, the lack of a thromboprophylaxis practice protocol, the difficulties in identifying patients at risk, insufficient knowledge of the recommendations in this area [10] [13] [14] [16]. A South African study evaluating the impact of communication for improving the practices of health professionals has shown that it allows a significant increase in the frequency of thromboprophylaxis in patients at risk, which increased from 4.6% to 36% [16]. In addition, studies support that the development of outpatient surgery and rapid rehabilitation after surgery (RRAS) has a positive impact on the efficacy of postoperative pharmacological thromboprophylaxis and would reduce its duration and therefore the cost of treatment [1].…”