Carneiro João Luiz de Aquino, Targueta Gabriel Pelegrineti, Marino Lucas Oliveira
Centro Integrado de Atenção à Saúde, CIAS, Vitória, ES, Brasil.
Rev Col Bras Cir. 2010 Jun;37(3):204-10. doi: 10.1590/s0100-69912010000300008.
This study aimed at assessing the adequacy of thromboprophylaxis in a high complexity hospital in Vitória-ES, analysing the possible predictors of inadequate prescriptions and/or procedures.
A cross-sectional study was carried out through prompt-book analysis. The included patients were hospitalized in 2007 and had their Venous thromboembolism (VTE) risk stratified using the 8th Edition of the American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines. The thromboprophylaxis adequacy was determined through a comparison between the adopted prescriptions and/or procedures and the guideline recommendations. EpiInfo 3.4.3 and SPSS 13.0 were the software applications used.
In 47% of the patients the thromboprophylaxis was inadequate, being the non-prescription of the indicated medication the major reason (33%). There was no statistically significant difference in inadequate tromboprophylaxis rate between clinical and surgical patients, or ward and Intensive care unit (ICU) ones. An inverse relationship was observed between the inadequate tromboprophylaxis rate and the number of VTE risk factors presented by the patients, as well as their age, and the length of hospital stay (p < 0.05).
The results show alarming levels of thromboprophylaxis inadequacy, inacceptable in these times of well-established published guidelines. Therefore, a continuing education program should be implanted for all the assistance team.
本研究旨在评估圣埃斯皮里图州维多利亚市一家高复杂性医院的血栓预防措施是否充分,分析处方和/或程序不充分的可能预测因素。
通过病历分析开展一项横断面研究。纳入的患者为2007年住院患者,根据美国胸科医师学会(ACCP)循证临床实践指南第8版对其静脉血栓栓塞(VTE)风险进行分层。通过比较所采用的处方和/或程序与指南建议来确定血栓预防措施是否充分。使用的软件应用程序为EpiInfo 3.4.3和SPSS 13.0。
47%的患者血栓预防措施不充分,主要原因是未开具指定药物(33%)。临床患者和外科患者之间、病房患者和重症监护病房(ICU)患者之间的血栓预防不充分率无统计学显著差异。观察到血栓预防不充分率与患者呈现的VTE风险因素数量、患者年龄以及住院时间之间呈负相关(p < 0.05)。
结果显示血栓预防不充分程度令人担忧,在已发布成熟指南的当下是不可接受的。因此,应为所有医护团队开展继续教育项目。