Review of thromboembolic prophylaxis in patients attending Cork University Hospital
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Stephen Byrne1, Daniel Timothy Weaver
1School of Pharmacy, University College Cork, Cork, Ireland. stephen.byrne@ucc.ie
Insights
Venous thromboembolism prophylaxis adherence is poor at Cork University Hospital, with only 37% of patients receiving appropriate treatment. Implementing a specific VTE prophylaxis protocol is recommended to improve guideline compliance.
Area of Science:
- Medical research
- Clinical practice guidelines
- Hospital quality improvement
Background:
- Venous thromboembolism (VTE) is a significant cause of hospital-acquired morbidity and mortality.
- Adherence to VTE prophylaxis guidelines, such as those from the American College of Chest Physicians (ACCP), remains inadequate in most healthcare settings.
Purpose of the Study:
- To evaluate the current use and adherence to VTE prophylaxis guidelines at Cork University Hospital.
- To identify areas for improvement in VTE prevention strategies within the hospital.
Main Methods:
- A retrospective review of 394 patients' medical charts, drug kardex, and laboratory results was conducted in April 2010.
- The Caprini score was calculated for each patient to assess VTE risk.
- Adherence to ACCP 8th edition guidelines for appropriate prophylaxis was determined based on collected data and risk assessment.
Main Results:
- Overall, 63% of patients received some form of VTE prophylaxis, with higher rates in surgical (76%) versus medical (54%) patients.
- Only 37% of all patients received appropriate thromboprophylaxis according to ACCP guidelines.
- Appropriate prophylaxis rates were 51% for surgical and 27% for medical patients.
Conclusions:
- Cork University Hospital demonstrates poor adherence to international VTE prophylaxis guidelines.
- Hospitals must develop formal strategies for VTE prevention.
- Developing, implementing, and re-evaluating a specific VTE prophylaxis protocol is recommended to enhance guideline adherence.
Background:
Although preventable, venous thromboembolism remains a common cause of hospital acquired morbidity and mortality. Guidelines, such as the one produced by the American College of Chest Physicians (ACCP), are aimed at reducing hospital associated venous thromboemboli. Unfortunately the majority of studies have revealed inadequate adherence to these guidelines.
Objective:
The objective of this study was to evaluate the use of venous thromboembolism prophylaxis at Cork University Hospital.
Setting:
Cork University Hospital, Wilton, Cork, Ireland.
Methods:
Data from the patient's chart, drug kardex and laboratory results were recorded during April 2010. A Caprini score, a venous thromboembolism risk factor assessment tool, was subsequently calculated for each patient based on data collected. Appropriate prophylaxis was determined after examining data collected, Caprini score and prophylactic regime according to the ACCP 8th edition guidelines.
Main Outcome Measure:
Primary outcome was to analyse adherence to VTE prophylaxis guidelines.
Results:
A total of 394 patients met the inclusion criteria and were reviewed, of which, 60% (n = 236) were medical and 37% (n = 146) were surgical patients. In total 63% of patients received some form of venous thromboembolism prophylaxis. Furthermore, 54% of medical and 76% of surgical patients received prophylaxis. However only 37% of the patients studied received appropriate thromboprophylaxis according to the ACCP 8th edition guidelines (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). Additionally 51% of surgical and 27% of medical patients received appropriate prophylaxis.
Conclusion:
Data collected from Cork University Hospital revealed poor adherence to international venous thromboembolism prophylaxis guidelines. As stated in the ACCP 8th edition guidelines, every hospital should develop a formal strategy for venous thromboembolism prevention (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). In order to improve adherence to guidelines, Cork University Hospital should develop, implement and re-evaluate a specific protocol for venous thromboembolism prophylaxis.
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