Venous thromboembolism prophylaxis guideline compliance: a pilot study of augmented medication charts

Abstract

Introduction

Venous thromboembolism (VTE) is a common complication of hospital admission. The incidence of hospital-acquired deep vein thrombosis is approximately 10–40 % amongst medical and general surgical patients without prophylaxis. Pulmonary embolism accounts for 5–10 % of deaths in hospitalised patients, making hospital-acquired VTE the most common preventable cause of in-hospital death. Studies suggest that prophylactic measures are widely under- and inappropriately used.

Aims

We hypothesised that the introduction of a medication chart with a dedicated VTE prophylaxis section would improve compliance with local guidelines.

Methods

Trial medication charts were piloted over a 4-week period in one surgical and two medical wards. Data on compliance with hospital guidelines were collected before and after introduction using a detailed chart review. The difference in prescribing compliance was assessed with the Chi-squared test.

Results

70 patients were assessed before and 38 after the introduction of the new charts. Initially, only 58.6 % (n = 41) of patients’ prescriptions were in compliance with local guidelines. In 28.6 % (n = 20) of patients, VTE prophylaxis was needed and not prescribed. 7.1 % (n = 5) of patients were prescribed an inappropriately low dose of low molecular weight heparin (LMWH) prophylaxis. 2.9 % (n = 2) of patients were prescribed inappropriately high dose of LMWH prophylaxis. After introduction of the new medication chart, compliance with guidelines rose to 71 % (n = 27, p = 0.09).

Conclusion

Compliance with VTE guidelines is inadequate. Medication charts with specific sections on VTE assessment and prophylaxis may increase compliance with guidelines.