The setting up and implementation of a venous thromboembolism prophylaxis policy in clinical hospital practice

Abstract

Clinical management policies are meant to lead to the delivery of better health care. However, as we demonstrate in this review, having an oral or written venous thromboembolism prophylaxis policy does not necessarily lead to the majority of general surgical inpatients receiving the appropriate prophylaxis. We discovered, through prospective clinical audit, that for a clinical policy to be effective in delivering the appropriate health care, it must be repeatedly scrutinized and implemented in the correct manner. Only after several rounds of the audit cycle were we able to achieve the deliverance of venous thromboembolism prophylaxis to the majority of general surgical patients on our unit. This has wider implications, not just for the implementation of a venous thromboembolism prophylaxis policy, but also for all clinical management policies, and illustrates the importance of clinical audit in clinical practice.

Audit in infection control

“…3 Attainment of standards may only be achieved after several rounds of the audit cycle. 4 Audits can be evaluated according to how many of the stages are completed using the Oxfordshire Medical Audit Advisory Group method. 5 If a topic is chosen and practice observed, the project is termed a 'potential' audit.…”

Increasing awareness about venous disease: The American Venous Forum expands the National Venous Screening Program

“…Despite a considerable wealth of knowledge that has been acquired over the past 25 years about the basic science, natural history, risk factor delineation, prevention, and treatments of these two common manifestations of venous disease, a significant proportion of physicians, allied health personnel, health care administrators, and, most importantly, the lay public continue to be conspicuously unaware of these advances. [1][2][3][4] Bridging this gap by involving the aforementioned groups in screening of Americans for venous disease represents a major goal of the American Venous Forum (AVF) to increase awareness of venous disease.Findings from the pilot launch of the National Venous Screening Program (NVSP) during 2005 and 2006, which involved 17 centers, were profound. 5 Important observations included 77% of participants were at high or very high risk of developing VTE if put in a high-risk situation; 40% and 6% had evidence of venous reflux or obstruction, respectively; and, according to the CEAP criteria, 6 20% had a clinical classification of 3 or greater.…”

“…Despite a considerable wealth of knowledge that has been acquired over the past 25 years about the basic science, natural history, risk factor delineation, prevention, and treatments of these two common manifestations of venous disease, a significant proportion of physicians, allied health personnel, health care administrators, and, most importantly, the lay public continue to be conspicuously unaware of these advances. [1][2][3][4] Bridging this gap by involving the aforementioned groups in screening of Americans for venous disease represents a major goal of the American Venous Forum (AVF) to increase awareness of venous disease.…”

Bridging the Gap Between Evidence and Practice in Venous Thromboembolism Prophylaxis: The Quality Improvement Process

“…However, the forms should be readily accessible, and a system of checks and follow-up should exist to ensure that they are completed; this is crucial during the form introduction phase. 31,32 For example, during the introduction of risk-factor assessment-protocol sheets in a UK surgical department, only a third of forms were completed. After completion checking by nursing staff was initiated, 96% of the forms were completed, 32 emphasizing that an active attitude is the key to QI initiative success.…”

“…31,32 For example, during the introduction of risk-factor assessment-protocol sheets in a UK surgical department, only a third of forms were completed. After completion checking by nursing staff was initiated, 96% of the forms were completed, 32 emphasizing that an active attitude is the key to QI initiative success. An example of an accessible risk assessment sheet is shown in Figure 2.…”