Bauer Tyler M, Johnson Adam P, Dukleska Katerina, Beck Johanna, Dworkin Myles S, Patel Kamini, Cowan Scott W, Merli Geno J
1 Thomas Jefferson University Hospital, Philadelphia, PA.
Am J Med Qual. 2019 Jul/Aug;34(4):402-408. doi: 10.1177/1062860618808378. Epub 2018 Oct 26.
Hospital-acquired venous thromboembolism (VTE) affects morbidity and mortality and increases health care costs. Poor adherence to recommended prophylaxis may be a potential cause of ongoing events. This study aims to identify institutional adherence rates and barriers to optimal VTE prophylaxis. The authors performed patient and nurse interviews and a concurrent review of clinical documentation, utilizing a cloud-based, HIPAA-compliant tool, on a convenience sample of hospitalized patients. Adherence and agreement between different assessment modalities were calculated. Seventy-six patients consented for participation. Nurse documented adherence was 66% (29/44), 44% (27/61), and 89% (50/56) for mechanical, ambulatory, and chemoprophylactic prophylaxis, respectively. Patient report and nurse documentation showed moderate agreement for mechanical and no agreement for ambulatory adherence (κ = 0.51 and 0.07, respectively). Concurrent review using a cloud-based tool can provide robust, timely, and relevant information on adherence to recommended VTE prophylaxis. Iterative concurrent reviews can guide efforts to improve adherence and reduce rates of hospital-acquired VTE.
医院获得性静脉血栓栓塞症（VTE）会影响发病率和死亡率，并增加医疗保健成本。对推荐预防措施的依从性差可能是持续发生此类事件的一个潜在原因。本研究旨在确定机构的依从率以及最佳VTE预防措施的障碍。作者使用一个基于云且符合《健康保险流通与责任法案》（HIPAA）的工具，对住院患者的便利样本进行了患者和护士访谈以及临床文档的同步审查。计算了不同评估方式之间的依从性和一致性。76名患者同意参与。护士记录的机械预防、非卧床预防和化学预防的依从率分别为66%（29/44）、44%（27/61）和89%（50/56）。患者报告与护士记录在机械预防方面显示出中度一致性，在非卧床预防依从性方面未显示出一致性（κ分别为0.51和0.07）。使用基于云的工具进行同步审查可提供关于对推荐的VTE预防措施依从性的可靠、及时且相关的信息。反复进行同步审查可指导提高依从性并降低医院获得性VTE发生率的工作。
