Venous thromboembolism prophylaxis guideline implementation is improved by nurse directed feedback and auditReport as inadecuate

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Thrombosis Journal

, 9:7

First Online: 05 April 2011Received: 13 October 2010Accepted: 05 April 2011


BackgroundVenous thromboembolism VTE is a major health and financial burden. VTE impacts health outcomes in surgical and non-surgical patients. VTE prophylaxis is underutilized, particularly amongst high risk medical patients. We conducted a multicentre clinical audit to determine the extent to which appropriate VTE prophylaxis in acutely ill hospitalized medical patients could be improved via implementation of a multifaceted nurse facilitated educational program.

MethodsThis multicentre clinical audit of 15 Australian hospitals was conducted in 2007-208. The program incorporated a baseline audit to determine the proportion of patients receiving appropriate VTE prophylaxis according to best practice recommendations issued by the Australian and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism ANZ-WP recommendations, followed by a 4-month education intervention program and a post intervention audit. The primary endpoint was to compare the proportion of patients being appropriately managed based on their risk profile between the two audits.

ResultsA total of 8774 patients audit 1; 4399 and audit 2; 4375 were included in the study, most 82.2% audit 1; and 81.0% audit 2 were high risk based on ANZ-WP recommendations. At baseline 37.9% of high risk patients were receiving appropriate thromboprophylaxis. This increased to 54.1% in the post intervention audit absolute improvement 16%; 95% confidence interval CI 11.7%, 20.5%. As a result of the nurse educator program, the likelihood of high risk patients being treated according to ANZ-WP recommendations increased significantly OR 1.96; 1.62, 2.37.

ConclusionUtilization of VTE prophylaxis amongst hospitalized medical patients can be significantly improved by implementation of a multifaceted educational program coordinated by a dedicated nurse practitioner.

Electronic supplementary materialThe online version of this article doi:10.1186-1477-9560-9-7 contains supplementary material, which is available to authorized users.

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Author: Harry Gibbs - John Fletcher - Peter Blombery - Renea Collins - David Wheatley


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