Patients at Risk for Blood Clots Are Not Receiving Recommended Treatment
Even after Educational Programs, Compliance by
Healthcare Providers Is Lacking, as Reported in the Canadian Journal of
Even after Educational Programs, Compliance by Healthcare Providers Is Lacking, as Reported in the Canadian Journal of Cardiology
Venous thromboembolism (VTE), encompassing deep-vein thrombosis (DVT), or blood clots in leg veins, and pulmonary embolism (PE), or clots that travel to the lungs, is the most common cause of preventable death in hospital settings. While these clots can be prevented by an approach called VTE prophylaxis, and this reduces mortality by as much as 80%, VTE prophylaxis is not universally prescribed for high-risk patients. In a study in the Canadian Journal of Cardiology, researchers found that even after educating healthcare providers about the need for VTE prophylaxis, significant numbers of patients did not receive the recommended treatment.
Investigators carried out chart reviews of patients in a university-affiliated, tertiary care cardiology center, which included a clinical teaching unit (CTU) and a coronary care unit (CCU). Audits were conducted three and five months before the introduction of an educational program on VTE prophylaxis protocol, followed by a second series of audits three and five months after protocol initiation.
Prior to the educational efforts, including a guideline-based protocol, 36% of all patients considered at risk for VTE did not receive prophylaxis. Surprisingly, three months after the program was initiated, 21% of patients were still not being treated according to the recommended guidelines, and that rose to 28% five months post-protocol.
“Awareness and education surrounding VTE prophylaxis is challenging in the inpatient teaching unit model due to a number of factors, including the high turnover of senior and junior physicians as well as nursing staff,” explained lead investigator Colette Seifer, MB (Hons), FRCP (UK), Associate Professor, Department of Internal Medicine, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada. “A single time point intervention is unlikely to result in a sustained improvement in VTE prophylaxis rates.”
In each set of audits, conducted over two months, three independent groups consisting of one physician and one nonphysician healthcare provider (nursing, pharmacy) each reviewed the data. Discrepancies were settled by the senior investigators. In the first set of audits, 173 charts for patients considered at high risk for VTE were evaluated. The second set of audits included 247 patients.
The investigators suggest that with the introduction of electronic patient records and innovative software programs, automated alerts and checklists have the potential to improve compliance rates. Nevertheless, they concluded that, “There is a high rate of noncompliance with accepted guidelines for the prevention of VTE. The introduction of a guideline-based protocol significantly increased compliance. However, a substantial proportion of patients at high risk for VTE, still did not receive prophylaxis.”
Notes for editors
“Venous Thromboembolism Prophylaxis on a Cardiology In-patient Unit: A Surprising Result?” by Mehrdad Golian; Motaz Moussa; Charlene White; Giuseppe Aletta; Lillian Koley; and Colette Seifer, DOI: 10.1016/j.cjca.2015.05.023. This article is published online in the Canadian Journal of Cardiology by Elsevier.
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About The Canadian Journal of Cardiology
The Canadian Journal of Cardiology (www.onlinecjc.ca) is the official journal of the Canadian Cardiovascular Society (www.ccs.ca). It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as a major venue for the results of Canadian cardiovascular research and Society guidelines. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, review articles, case reports, and papers on health outcomes, policy research, ethics, medical history, and political issues affecting practice.
Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.
About The Canadian
The Canadian Cardiovascular Society is the professional association for Canadian cardiovascular physicians and scientists working to promote cardiovascular health and care through knowledge translation, professional development, and leadership in health policy. The CCS provides programs and services to its 1900+ members and others in the cardiovascular community, including guidelines for cardiovascular care, the annual Canadian Cardiovascular Congress, and, with the Canadian Cardiovascular Academy, programs for trainees. More information about the CCS and its activities can be found at www.ccs.ca.
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