BACKGROUND: Venous thromboembolism (VTE) is a significant contributor to morbidity and mortality in Australia. While there is well-established evidence for the use of VTE prophylaxis in hospital inpatients, adherence to such guidelines is poor. AIM: The aim of the present study is to assess the impact of education and system change on improving rates of VTE prophylaxis in hospital inpatients. METHODS: We performed four consecutive audits of inpatient medical records of a regional hospital service over 2 years. The audits aimed to test the impact of serial interventions at increasing the appropriate use of VTE prophylaxis (based on risk assessment). The interventions were (i) staff education and (ii) a process change that mandated a prophylaxis decision by modifying the National Inpatient Medication Chart with 'VTE avoidance' preprinted in the first medication box. RESULTS: Our results from the baseline study showed that of the 236 medical inpatients reviewed, 80% were at high risk of VTE. Of this high-risk cohort, 34.9% (confidence interval (CI) 28-42%) had appropriate prophylaxis decisions. Post the education intervention, 43.2% (CI 37-49%) of the high-risk cohort received appropriate VTE prophylaxis, an improvement of 8.3% (CI -1% to 18%) from baseline. With the subsequent introduction of a process change, 82.1% (CI 66-92%) of the high-risk cohort received appropriate prophylaxis, an improvement of 47.2% and 38.8% (CI 24-54%) when compared with baseline and education respectively. Retention rates at 11 months postsystem change were 73% (CI 55-86%). CONCLUSIONS: This study therefore concluded that while education has an impact on rates of appropriate VTE prophylaxis, it is system change that has the most marked and sustained effect.
BACKGROUND:Venous thromboembolism (VTE) is a significant contributor to morbidity and mortality in Australia. While there is well-established evidence for the use of VTE prophylaxis in hospital inpatients, adherence to such guidelines is poor. AIM: The aim of the present study is to assess the impact of education and system change on improving rates of VTE prophylaxis in hospital inpatients. METHODS: We performed four consecutive audits of inpatient medical records of a regional hospital service over 2 years. The audits aimed to test the impact of serial interventions at increasing the appropriate use of VTE prophylaxis (based on risk assessment). The interventions were (i) staff education and (ii) a process change that mandated a prophylaxis decision by modifying the National Inpatient Medication Chart with 'VTE avoidance' preprinted in the first medication box. RESULTS: Our results from the baseline study showed that of the 236 medical inpatients reviewed, 80% were at high risk of VTE. Of this high-risk cohort, 34.9% (confidence interval (CI) 28-42%) had appropriate prophylaxis decisions. Post the education intervention, 43.2% (CI 37-49%) of the high-risk cohort received appropriate VTE prophylaxis, an improvement of 8.3% (CI -1% to 18%) from baseline. With the subsequent introduction of a process change, 82.1% (CI 66-92%) of the high-risk cohort received appropriate prophylaxis, an improvement of 47.2% and 38.8% (CI 24-54%) when compared with baseline and education respectively. Retention rates at 11 months postsystem change were 73% (CI 55-86%). CONCLUSIONS: This study therefore concluded that while education has an impact on rates of appropriate VTE prophylaxis, it is system change that has the most marked and sustained effect.