Improving guideline compliance: assessment of unit-based reminder for monitoring platelet counts post-PCI

Area of Science:

• Cardiology
• Clinical Practice Improvement

Background:

• Vascular access site bleeding is a complication after percutaneous coronary interventions (PCI).
• Manufacturer guidelines for glycoprotein (GP) IIb/IIIa agents recommend specific platelet count monitoring, which was anecdotally found to be low.
• Compliance with platelet count monitoring post-PCI using GP IIb/IIIa agents was suboptimal in the catheterization recovery unit (CRU) and coronary care unit (CCU).

Purpose of the Study:

• To assess the effectiveness of a unit-focused reminder system to improve cardiologist compliance with ordering platelet counts after PCI.
• To evaluate changes in platelet count measurement rates following the implementation of a reminder intervention.

Main Methods:

• A reminder system was implemented for cardiologists to order platelet counts post-PCI with GP IIb/IIIa agents.
• Platelet count measurement rates were compared before and after the reminder intervention in the CRU and CCU.
• Compliance with manufacturer guidelines for platelet count monitoring was analyzed.

Main Results:

• The reminder effort led to an increase in the number of patients having platelet counts drawn.
• The CRU demonstrated significant increases in platelet count draws post-reminder for both first and second draws.
• Despite increases, aggregate post-reminder results did not show significant changes in meeting the specific guideline parameters for platelet measurement.

Conclusions:

• A standard operating procedure, implemented as a reminder system, can positively impact clinical practice, even if not fully meeting stringent prescribing guidelines.
• Unit-focused interventions can improve adherence to recommended monitoring protocols for cardiovascular medications.
• Further strategies may be needed to achieve full compliance with platelet count monitoring guidelines after GP IIb/IIIa agent administration.