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Improving VTE risk assessment and prophylaxis prescribing rate in medical patients: integrating risk assessment tool into the workflow
  1. Hannah Preston1,
  2. Iain Swan1,
  3. Lauren Davies1,
  4. Simon Dummer1,
  5. Veiraiah Aravindan2,
  6. Yuan Ye Beh1,
  7. Ann Lockman1
  1. 1Acute and General Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2SPSP Medicines, Healthcare Improvement Scotland, Edinburgh, UK
  1. Correspondence to Dr Hannah Preston; hannah.preston{at}nhslothian.scot.nhs.uk

Abstract

Medical inpatients often have important risk factors for venous thromboembolism (VTE). In our institution, VTE prophylaxis in this group was underused. The main barriers identified were inattention to VTE prophylaxis, competing priorities and lack of confidence in the decision-making. We aimed to improve the rate of VTE prophylaxis use by introducing a paper-based risk assessment tool, with actionable management recommendations within the prescription chart. The rationale was that an assessment tool at the point of prescribing can reduce steps between decision-making and prescribing process, thus promoting confidence and acting as a reminder. A total of 552 prescription charts completed over a period of 29 weeks were examined during the baseline period. In the postintervention period, 871 charts completed over 40 weeks period were examined. The risk assessment tool was completed in 51% of the cases examined in the postintervention period. The introduction of the risk assessment tool was associated with a significant change in the pattern of VTE pharmacological prophylaxis use. The change occurred when the form was made highly visible and enclosed in the prescription chart. The pharmacological prophylaxis use was higher with a completed assessment form than without (mean (SD) 97.5% (7.6%) vs 70.1% (19.4%); p<0.0001). The rate of appropriate prophylaxis decision was 98.2% (SD 5.2%) with a completed assessment form, and 80.7% (SD 17.9%) when it was not used. The qualitative interviews revealed positive themes; many users found it useful, easy and convenient to use. Our data have shown that a paper-based VTE risk assessment tool placed within the prescription chart could substantially improve the rate of appropriate assessment and VTE prophylaxis implementation. This suggests that tool clearly needs to be a seamless integration into the workflow to capture users’ attention and mitigate the influence of time perception.

  • venous thromboembolism
  • quality improvement
  • patient safety
  • medication safety
  • clinical practice guidelines
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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors HP planned, collected data, drafted and revised, submitted the study. AL planned, collected data and drafted the study. IS planned and collected data. VA analysed the data and designed the statistical analysis, reviewed and revised the study. LD and SD collated data and reviewed the study. YYB collated data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This was deemed as a quality improvement project by a governance committee in our institution, hence no formal ethical approval was sought.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relavant to the study are included in the study article.

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