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一项有说服力的干预措施:提高三级结直肠和肝胆科单位癌症切除术后延长静脉血栓栓塞预防的依从性。

A persuasive intervention: improving the compliance of extended venous thromboembolism prophylaxis following cancer resections in a tertiary colorectal and hepatobiliary unit.

作者信息

Yong Yao Pey, Karangizi Alvin, Banerjea Ayan

机构信息

Queen's Medical Centre, England.

出版信息

BMJ Qual Improv Rep. 2014 Oct 29;3(1). doi: 10.1136/bmjquality.u202594.w2216. eCollection 2014.

Abstract

Extended venous thromboembolism (VTE) prophylaxis has been shown to reduce the incidence of VTE in patients following cancer resections.[1] However, ensuring patients are discharged with the prescription remains a challenge, with junior doctors frequently rotating throughout different specialties. We conducted an audit to assess the compliance rate in the colorectal and hepatobiliary (HPB) unit at the Queen's Medical Centre in Nottingham. Extended VTE prophylaxis was considered compliant to the guideline if it was prescribed on discharge. The baseline measurement demonstrated compliance rates of 79% and 48% in the colorectal and HPB units respectively. Following discussion with the stakeholders, several interventions that include education and visual reminders were implemented to increase awareness of the importance of extended VTE prophylaxis among junior doctors. Results of the re-audit have shown a remarkable improvement; compliance rates were increased to 93% and 72% in the colorectal and HPB units respectively. We conclude that visual reminder is a simple yet effective tool to improve awareness among junior doctors on the importance of extended VTE prophylaxis in cancer patients. Nevertheless, education remains crucial to ensure the sustainability of any intervention.

摘要

延长静脉血栓栓塞症(VTE)预防措施已被证明可降低癌症切除术后患者的VTE发生率。[1]然而,确保患者出院时携带该处方仍然是一项挑战,因为初级医生经常在不同专科间轮转。我们进行了一项审计,以评估诺丁汉女王医疗中心结直肠和肝胆胰(HPB)科的合规率。如果在出院时开具了延长VTE预防措施,则认为其符合指南。基线测量显示,结直肠科和HPB科的合规率分别为79%和48%。在与利益相关者讨论后,实施了包括教育和视觉提醒在内的多项干预措施,以提高初级医生对延长VTE预防重要性的认识。重新审计的结果显示有显著改善;结直肠科和HPB科的合规率分别提高到了93%和72%。我们得出结论,视觉提醒是提高初级医生对癌症患者延长VTE预防重要性认识的一种简单而有效的工具。尽管如此,教育对于确保任何干预措施的可持续性仍然至关重要。

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