The Effects of a Multifaceted Intervention to Improve Venous Thromboembolism Prophylaxis are Sustained Over Time

ABSTRACT

Background: The majority of venous thromboembolic events occur in hospitalized patients. Although there are several effective regimens, venous thromboembolism (VTE) prophylaxis is still under-utilized in medically-ill patients. In 2003 a multi-faceted quality improvement intervention was implemented to improve the use of VTE prophylaxis. We previously described the significant improvements in VTE prophylaxis in the two years following this intervention.

To determine the longitudinal effects of this quality improvement intervention in prescribing practices for VTE prophylaxis in medically-ill patients.

Since the original intervention in 2002, the only on-going maintenance has been 4 annual lectures. We collected data on 121 medically-ill patients hospitalized in 2006, including risk factors for VTE, pharmacologic agent and dose prescribed (or mechanical devices, if uses), and timing of prophylaxis in relation to admission.

Overall, 83% were at high-risk for VTE and 77% received prophylaxis, a significant improvement compared to the 2002 pre-intervention cohort (40%, p<0.001) and similar to the 2003 post-intervention cohort (72%). Significantly more patients received preferred regimens for VTE prophylaxis in 2006 compared to 2002. Pneumatic compression devices, unfractionated heparin (UFH) 5,000 units TID, low molecular weight heparin (LMWH), and UFH 5,000 units BID were prescribed in 28%, 40%, 38%, and 3% respectively. Prophylaxis was prescribed within the first 24 hours of admission in 88%, 24-48 hours in 8%, and after 48 hours in 4%.

We have demonstrated that a multifaceted quality improvement intervention leads to a sustained improvement in the use of preferred VTE prophylaxis prescribing practices. The maintenance of these effects has been minimal, consisting of four 1-hour long educational sessions per year targeted to clinical pharmacists and medicine residents.

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