Myers Melissa K, Jansson-Knodell Claire L, Schroeder Darrell R, O'Meara John G, Bonnes Sara L, Ratelle John T
Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Health Sceinces Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
J Multidiscip Healthc. 2018 Sep 18;11:467-472. doi: 10.2147/JMDH.S171745. eCollection 2018.
Low-molecular-weight heparin (LMWH) is an effective means of preventing venous thromboembolism (VTE) among medical inpatients. Compared with unfractionated heparin, LMWH is equivalent or superior in efficacy and risk of bleeding. Despite its advantages, LMWH is underused in VTE prophylaxis for general-medicine patients hospitalized at our institution. Thus, a quality improvement (QI) initiative was undertaken to increase LMWH use for VTE prophylaxis among medical patients hospitalized on resident teaching services.
A QI team was formed, consisting of resident and attending physicians with pharmacy leaders. A systems analysis was performed, which showed gaps in resident knowledge as the greatest barrier to LMWH use. A knowledge translation framework was used to improve prescribing practices. Several Plan-Do-Study-Act cycles were executed, including resident-of-resident and pharmacist-of-resident education with performance audit and feedback.
Pharmacist-of-resident education elicited the largest improvement and was sustained through a recurring pharmacist-led, interprofessional educational session as part of the monthly hospital orientation for incoming residents. Data analysis showed a statistically significant increase in LMWH use among treatment-eligible hospitalized medical patients, from 12.1% to 69.2%, following intervention (<0.001). Extrapolated over 1 year, this improvement conserved 9,490 injections and nearly 791 hours of nurse time.
This QI project indicates that an interprofessional education intervention can lead to sustainable improvement in resident prescribing practices. This project also highlights the value of knowledge translation for the design of tailored interventions in QI initiatives.
低分子量肝素（LMWH）是预防内科住院患者静脉血栓栓塞症（VTE）的有效手段。与普通肝素相比，LMWH在疗效和出血风险方面相当或更具优势。尽管有这些优点，但在我们机构住院的普通内科患者的VTE预防中，LMWH的使用不足。因此，开展了一项质量改进（QI）计划，以增加在住院医师教学服务中住院的内科患者使用LMWH进行VTE预防的比例。
成立了一个QI团队，由住院医师、主治医生和药学负责人组成。进行了系统分析，结果显示住院医师知识方面的差距是LMWH使用的最大障碍。采用知识转化框架来改进处方行为。执行了几个计划-实施-研究-改进循环，包括住院医师之间的教育以及药师对住院医师的教育，并进行绩效审核和反馈。
药师对住院医师的教育带来了最大的改进，并通过由药师主导的定期跨专业教育课程得以维持，该课程是每月为新入院住院医师举办的医院迎新活动的一部分。数据分析显示，经过干预后，符合治疗条件的住院内科患者中LMWH的使用量从12.1%增至69.2%，具有统计学显著差异（<0.001）。按一年推算，这一改进节省了9490次注射以及近791小时的护士工作时间。
该QI项目表明，跨专业教育干预可使住院医师的处方行为得到可持续改进。该项目还凸显了知识转化在QI计划中设计针对性干预措施方面的价值。
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