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

[摘要] ENGLISH 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 thrombo-embolism (VTE). Despite the availability of highly effective thromboprophylaxis in prevent-ing VTE, numerous studies worldwide have demonstrated its under-utilization. The aim of this study was to review and improve the utilization of thromboprophylaxis in the prevention of VTE in hospitalized patients at Oudtshoorn district hospital.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 5 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 for-mal VTE risk assessment documented; 3) Every adult admission who is at risk for VTE should receive thromboprophylaxis.Results: Thirty eight percent 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<0.00001). In the pre-intervention group only 4.6 per-cent of patients who were at risk of VTE received thromboprophylaxis. There was a statisti-cally significant difference in the number of patients at risk who received thromboprophylax-is in the post-intervention group where 36% of these patients received thromboprophylaxis (p<0.00001).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.

[发布机构] Stellenbosch University