Nurse educator improves VTE prophylaxis rates
MedWire News: Use of venous thromboembolism (VTE) prophylaxis among hospitalized medical patients can be significantly improved by implementation of a nurse-led educational program, Australian researchers report.
Harry Gibbs (Lismore Base Hospital, New South Wales) and colleagues say that their results "provide encouragement and support to those seeking to implement change."
The researchers carried out two clinical audits at 15 Australian hospitals: one at baseline to determine the proportion of patients receiving appropriate VTE prophylaxis according to the Australian and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism (ANZ-WP) guidelines, and a second after a 4-month education intervention program designed to improve prophylaxis use.
The intervention program was directed by a full-time nurse educator and comprised active educational sessions, paper and verbal reminders, and feedback of the initial audit results.
In total, 8774 patients (4399 in audit 1 and 4375 in audit 2) were included in the study; around 80% were considered high-risk for VTE, based on ANZ-WP recommendations.
Gibbs and team report in the Thrombosis Journal that 37.9% of high-risk patients were receiving appropriate thromboprophylaxis at baseline. This increased to 54.1% in the post-intervention audit, giving an absolute improvement of 16.2%.
The researchers note that the observed improvement was a result of an increase in both the number of patients prescribed anticoagulants and the number receiving compression stockings when a contraindication to anticoagulation was present.
The likelihood of high-risk patients being treated according to ANZ-WP recommendations increased by a significant 96% following the implementation of the program, remarks the team.
However, they note that having only one post-implementation audit makes it difficult to determine whether the improvements would be maintained over the longer term. "Ongoing support appears to be a key component of success in this respect," they say.
Giibs and co-authors conclude that the employment of a full-time prophylaxis nurse, plus a combination of audit and feedback, education, and visual reminders "significantly increased the rate of appropriate VTE prophylaxis in acutely ill hospitalized medical patients."
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By Laura Dean