Internal Medicine, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia.
Ann Thorac Med. 2011 Apr;6(2):82-4. doi: 10.4103/1817-1737.78425.
In hospital, deep vein thrombosis (DVT) increases the morbidity and mortality in patients with acute medical illness. DVT prophylaxis is well known to be effective in preventing venous thromoembolism (VTE). However, its use remains suboptimal. The objective of this study was to evaluate the impact of quality improvement project on adherence with VTE prophylaxis guidelines and on the incidence of hospital-acquired VTEs in medical patients.
The study was conducted at Saudi Aramco Medical Services Organization from June 2008 to August 2009. Quality improvement strategies included education of physicians, the development of a protocol, and weekly monitoring of compliance with the recommendations for VTE prophylaxis as included in the multidisciplinary rounds. A feedback was provided whenever a deviation from the protocol occurs.
During the study period, a total of 560 general internal medicine patients met the criteria for VTE prophylaxis. Of those, 513 (91%) patients actually received the recommended VTE prophylaxis. The weekly compliance rate in the initial stage of the intervention was 63% (14 of 22) and increased to an overall rate of 100% (39 of 39) (P = 0.002). Hospital-acquired DVT rate was 0.8 per 1000 discharges in the preintervention period and 0.5 per 1000 discharges in the postintervention period, P = 0.51. However, there was a significant increase in the time-free period of the VTE and we had 11 months with no single DVT.
In this study, the use of multiple interventions increased VTE prophylaxis compliance rate.
在医院中，深静脉血栓形成（DVT）会增加急性内科疾病患者的发病率和死亡率。DVT 预防被公认为可有效预防静脉血栓栓塞症（VTE）。然而，其使用率仍然不理想。本研究旨在评估质量改进项目对遵守 VTE 预防指南以及预防内科住院患者发生医院获得性 VTE 的影响。
该研究于 2008 年 6 月至 2009 年 8 月在沙特阿美医疗服务组织进行。质量改进策略包括对医生进行教育、制定方案以及每周监测多学科查房时遵守 VTE 预防建议的情况。一旦出现与方案不符的情况，将提供反馈。
在研究期间，共有 560 名普通内科患者符合 VTE 预防标准。其中，513 名（91%）患者实际接受了推荐的 VTE 预防措施。干预初始阶段的每周遵医嘱率为 63%（14/22），并提高到总体 100%（39/39）（P=0.002）。干预前医院获得性 DVT 发生率为每 1000 例出院 0.8 例，干预后为每 1000 例出院 0.5 例，P=0.51。然而，VTE 无事件期显著延长，我们有 11 个月没有发生单一的 DVT。
在这项研究中，多种干预措施的使用提高了 VTE 预防措施的遵医嘱率。
