Results of a venous thromboembolism prophylaxis program for hospitalized patients

Abstract

Introduction: Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed.

Objective: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital.

Patients and methods: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel-Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05.

Results: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033).

Conclusion: The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records.

Keywords: deep venous thrombosis; patient safety; prevention and control; pulmonary embolism; quality control.

Figure 1

Absolute number of patients assessed for VTE risk within 24 hours after admission and total number of admitted adult patients from 2010 to 2014. Abbreviation: VTE, venous thromboembolism.

Figure 2

Percent of patients assessed for VTE risk within 24 hours after admissions from 2010 to 2014. Abbreviation: VTE, venous thromboembolism.

Figure 3

Percent of patients adherence to chemical and/or mechanical prophylaxis recommendations from 2010 to 2014.

Figure 4

Percent of discharged patients with a primary or secondary diagnosis of VTE from 2009 to 2014. Abbreviation: VTE, venous thromboembolism.