Comparison of strategies for adherence to venous thromboembolism prophylaxis in high-risk surgical patients: a before and after intervention study

BMJ Open Quality

article

Leopoldo Muniz da Silva¹  Helidea de Oliveira Lima²  Ricardo Ferrer³  Anthony M-H Ho⁴  Saullo Queiroz Silveira¹  Arthur de Campos Vieira Abib¹  Fernando Nardy Bellicieri¹  Daenis Camire⁴  Otto Mittermayer¹  Karen Kato Botelho³  Andre Mortari Pla Gil¹  Glenio B Mizubuti⁴ 

[1] Anesthesiology , São Luiz Hospital-ITAIM/Rede D’Or–CMA Anaesthesia Team;Department of Care Quality;Nursing , São Luiz Hospital-ITAIM/Rede D’Or–CMA;Anesthesiology and Perioperative Medicine , Queen’s University

关键词: continuous quality improvement;    continuity of patient care;    healthcare quality improvement;    medication safety;   

DOI  :  10.1136/bmjoq-2021-001583

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Venous thromboembolism (VTE) is a major cause of perioperative morbimortality. Despite significant efforts to advance evidence-based practice, prevention rates remain inadequate in many centres.Objective To evaluate the effectiveness of different strategies aimed at improving adherence to adequate VTE prophylaxis in surgical patients at high risk of VTE.Method Before and after intervention study conducted at a tertiary hospital. Adherence to adequate VTE prophylaxis was compared according to three strategies consecutively implemented from January 2019 to December 2020. A dedicated hospitalist physician alone (strategy A) or in conjunction with a nurse (strategy B) overlooked the postoperative period to ensure adherence and correct inadequacies. Finally, a multidisciplinary team approach (strategy C) focused on promoting adequate VTE prophylaxis across multiple stages of care—from the operating room (ie, preoperative team-based checklist) to collaboration with clinical pharmacists in the postoperative period—was implemented.Results We analysed 2074 surgical patients: 783 from January to June 2019 (strategy A), 669 from July 2019 to May 2020 (strategy B), and 622 from June to December 2020 (strategy C). VTE prophylaxis adherence rates for strategies (A), (B) and (C) were (median (25th–75th percentile)) 43.29% (31.82–51.69), 50% (42.57–55.80) and 92.31% (91.38–93.51), respectively (pA=B). There was a significant reduction in non-compliance on all analysed criteria (risk stratification (A (25.5%), B (22%), C (6%)), medical documentation (A (68%), B (55.2%) C (9%)) and medical prescription (A (51.85%), B (48%), C (6.10%)) after implementation of strategy C (p<0.05). Additionally, a significant increase in compliance with adequate dosage, dosing interval and scheduling of the prophylactic regimen was observed.Conclusion Perioperative VTE prophylaxis strategies that relied exclusively on physicians and/or nurses were associated with suboptimal execution and prevention. A multidisciplinary team-based approach that covers multiple stages of patient care significantly increased adherence to adequate VTE prophylaxis in surgical patients at high risk of developing perioperative VTE.

【 授权许可】

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