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Intervention targeted at nurses to improve venous thromboprophylaxis
Jose Labarere1, Jean-Luc Bosson, Marie-Antoinette Sevestre
1Unité d'Evaluation Médicale, Pavillon Taillefer, Centre Hospitalier Universitaire, BP 217, 38043 Grenoble Cedex 9, France. jLabarere@chu-grenoble.fr
Summary
Including nurses in venous thromboprophylaxis interventions for older patients significantly increased patient mobilization. However, this approach did not change the use of elastic stockings or anticoagulants, with similar deep vein thrombosis rates observed.
Area of Science:
- Geriatrics
- Internal Medicine
- Public Health
Background:
- Venous thromboembolism (VTE) is a significant concern in older patients post-acute care.
- Effective VTE prophylaxis, including mobilization, is crucial for patient outcomes.
- Current guidelines recommend comprehensive prophylaxis, but implementation varies.
Purpose of the Study:
- To compare the effectiveness of a VTE prophylaxis intervention targeting physicians and nurses versus physicians only.
- To evaluate the impact on patient mobilization, elastic stocking use, and anticoagulant prophylaxis.
Main Methods:
- A cluster randomized trial was conducted in 50 hospital-based post-acute care departments in France.
- The intervention involved implementing a clinical practice guideline for VTE prophylaxis.
- Older patients (≥65 years) were included, with outcomes assessed for mobilization, stocking use, and anticoagulation.
Main Results:
- The intervention targeting both physicians and nurses showed a significantly higher rate of patient mobilization (62% vs. 37%) compared to physicians-only targeting.
- Rates of elastic stocking and anticoagulant use were comparable between the two intervention groups.
- No significant differences were observed in deep vein thrombosis, bleeding, or thrombocytopenia rates.
Conclusions:
- A multifaceted intervention involving nurses alongside physicians enhances older patient mobilization for VTE prevention.
- This combined approach did not significantly alter the use of elastic stockings or anticoagulants.
- Differential dropout of departments may have influenced baseline characteristics and study outcomes.
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