Ensuring timely thromboprophylaxis on a Medical Assessment Unit

Area of Science:

• Medical Safety
• Pharmacology
• Quality Improvement

Background:

• Hospital-acquired venous thromboembolism (VTE) is a critical patient safety issue, defined as VTE occurring within 90 days of hospital admission or surgery.
• NICE guidelines recommend timely pharmacological prophylaxis for at-risk medical patients to prevent VTE.
• Lack of awareness regarding updated VTE guidelines contributed to delays in prophylaxis administration.

Purpose of the Study:

• To improve the timely prescription of VTE pharmacological prophylaxis (enoxaparin) within 6 hours of admission in a medical assessment unit.
• To achieve 100% adherence to the 6-hour enoxaparin prescribing target by May 2016.

Main Methods:

• A quality improvement project utilizing the Plan-Do-Study-Act (PDSA) methodology was implemented.
• Key interventions included an education program and the development of a local VTE prevention care pathway.
• The primary outcome measure was the time to first dose of enoxaparin administration.

Main Results:

• Baseline data showed only 29% of patients received enoxaparin within 6 hours, with a mean delay of 12 hours 22 minutes.
• Following interventions, PDSA Cycle 1 showed 71% of patients met the target, with a reduced mean delay to 5 hours 52 minutes.
• PDSA Cycle 2 further improved adherence to 83%, with a mean delay of 5 hours 7 minutes.

Conclusions:

• The implementation of simple change methodologies, including education and a care pathway, significantly improved enoxaparin prescribing practices.
• These improvements have the potential to reduce morbidity and mortality associated with hospital-acquired thrombosis (HAT).
• Optimizing VTE prophylaxis can also lead to cost savings in patient management.