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Modification of the National Inpatient Medication Chart improves venous thromboembolism prophylaxis rates in high-risk medical patients

Yates, M., Reddy, M., Machumpurath, B., Phelps, G. and Hampson, S.A. 2014, Modification of the National Inpatient Medication Chart improves venous thromboembolism prophylaxis rates in high-risk medical patients, Internal medicine journal, vol. 44, no. 2, February, pp. 190-194, doi: 10.1111/imj.12346.

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Title Modification of the National Inpatient Medication Chart improves venous thromboembolism prophylaxis rates in high-risk medical patients
Author(s) Yates, M.
Reddy, M.
Machumpurath, B.
Phelps, G.
Hampson, S.A.
Journal name Internal medicine journal
Volume number 44
Issue number 2
Season February
Start page 190
End page 194
Total pages 5
Publisher Wiley
Place of publication London, Eng.
Publication date 2014
ISSN 1445-5994
Keyword(s) education
enoxaparin
evidence-based practice
prophylaxis
venous thromboembolism
Summary 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.
Language eng
DOI 10.1111/imj.12346
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2014, Wiley
Persistent URL http://hdl.handle.net/10536/DRO/DU:30064447

Document type: Journal Article
Collection: School of Medicine
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