2.50
Hdl Handle:
http://hdl.handle.net/10755/157779
Type:
Presentation
Title:
Inadequate Use of Venous Thromboembolism Prevention Guidelines
Abstract:
Inadequate Use of Venous Thromboembolism Prevention Guidelines
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Lee, Jung-Ah, Ph.D.
P.I. Institution Name:University of California, Irvine, Program in Nursing Science
Title:Assistant Professor
Contact Address:903 Gabrielino Drive, Irvine, CA, 92617, USA
Contact Telephone:949-824-6706
Co-Authors:Brenda K. Zierler, PhD, Associate Professor
Purpose: Venous thromboembolism (VTE) is one of the most common clinical disorders in hospitalized patients in the United States. The purpose of this study was to describe current practices on VTE prophylaxis in hospitalized surgical patients. Background: The evidence to support the use of prophylaxis to prevent VTE has been available for years, yet VTE remains a problem in hospitalized patients. The Centers for Medicare and Medicaid Services (CMS) in partnership with the National Quality Forum and the Joint Commission have developed measures for reporting VTE prophylaxis in hospitalized patients. Financial incentives and disincentives are also being provided by CMS as a mechanism to improve the reporting of VTE prophylaxis. In 2009, CMS will stop paying for VTE when it is acquired during a hospitalization. Methods: This study was a descriptive study to evaluate the current practice on VTE prevention. We conducted retrospective chart reviews on a random sample of 100 surgical inpatients at an academic medical center during a 6-month period. Inclusion criteria was adult inpatients (greater than or equal to 18) who underwent any major surgery (procedure time > 3 hours). The American College of Chest Physicians' 2004 Guidelines including surgical risk stratification and recommended prevention strategies were used to assess adequate use of VTE prophylaxis. VTE episodes were documented within 3 months after surgery. Results: Approximately half of the eligible patients received pharmacologic prophylaxis (51%, 49/95). Among those, inadequate doses of prophylaxis were used in 45% (22/49) of the patients (over dosing in patients with moderate risk or under dosing in patients at highest risk). Neither pharmacologic prophylaxis nor mechanical compression devices were utilized in 9 eligible patients. In a 3-month follow-up of VTE episodes after surgery, 13 patients underwent a diagnostic study (venous duplex scanning on lower extremities or lung scanning) to rule out VTE and among those 11 patients received VTE prophylaxis. One  patient who was diagnosed with pulmonary embolism did not receive any prophylaxis  before or after surgery. Conclusions: Preventive measures for VTE including both pharmacologic and mechanical prophylaxis were underused in patients undergoing major surgery. This study confirmed the inadequate use of prophylaxis in current clinical practice. The data from this study will be disseminated to providers, administrators, and the Patient Safety Committee. An effort to decrease the incidence of VTE through increasing appropriate use of VTE prophylaxis and assessment is ongoing.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleInadequate Use of Venous Thromboembolism Prevention Guidelinesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157779-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Inadequate Use of Venous Thromboembolism Prevention Guidelines</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Lee, Jung-Ah, Ph.D.</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of California, Irvine, Program in Nursing Science</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">903 Gabrielino Drive, Irvine, CA, 92617, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">949-824-6706</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jungahl@uci.edu, leeanna71@yahoo.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Brenda K. Zierler, PhD, Associate Professor</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Venous thromboembolism (VTE) is one of the most common clinical disorders in hospitalized patients in the United States. The purpose of this study was to describe current practices on VTE prophylaxis in hospitalized surgical patients. Background: The evidence to support the use of prophylaxis to prevent VTE has been available for years, yet VTE remains a problem in hospitalized patients. The Centers for Medicare and Medicaid Services (CMS) in partnership with the National Quality Forum and the Joint Commission have developed measures for reporting VTE prophylaxis in hospitalized patients. Financial incentives and disincentives are also being provided by CMS as a mechanism to improve the reporting of VTE prophylaxis. In 2009, CMS will stop paying for VTE when it is acquired during a hospitalization. Methods: This study was a descriptive study to evaluate the current practice on VTE prevention. We conducted retrospective chart reviews on a random sample of 100 surgical inpatients at an academic medical center during a 6-month period. Inclusion criteria was adult inpatients (greater than or equal to 18) who underwent any major surgery (procedure time &gt; 3 hours). The American College of Chest Physicians' 2004 Guidelines including surgical risk stratification and recommended prevention strategies were used to assess adequate use of VTE prophylaxis. VTE episodes were documented within 3 months after surgery. Results: Approximately half of the eligible patients received pharmacologic prophylaxis (51%, 49/95). Among those, inadequate doses of prophylaxis were used in 45% (22/49) of the patients (over dosing in patients with moderate risk or under dosing in patients at highest risk). Neither pharmacologic prophylaxis nor mechanical compression devices were utilized in 9 eligible patients. In a 3-month follow-up of VTE episodes after surgery, 13 patients underwent a diagnostic study (venous duplex scanning on lower extremities or lung scanning) to rule out VTE and among those 11 patients received VTE prophylaxis. One &nbsp;patient who was diagnosed with pulmonary embolism did not receive any prophylaxis &nbsp;before or after surgery. Conclusions: Preventive measures for VTE including both pharmacologic and mechanical prophylaxis were underused in patients undergoing major surgery. This study confirmed the inadequate use of prophylaxis in current clinical practice. The data from this study will be disseminated to providers, administrators, and the Patient Safety Committee. An effort to decrease the incidence of VTE through increasing appropriate use of VTE prophylaxis and assessment is ongoing.</td></tr></table>en_GB
dc.date.available2011-10-26T20:11:47Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:11:47Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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