Anesthesiology, São Luiz Hospital-ITAIM/Rede D'Or-CMA Anaesthesia Team, São Paulo, Brazil
Department of Care Quality, Quality Improvement Board-Rede D'Or, São Paulo, Brazil.
BMJ Open Qual. 2021 Oct;10(4). doi: 10.1136/bmjoq-2021-001583.
Venous thromboembolism (VTE) is a major cause of perioperative morbimortality. Despite significant efforts to advance evidence-based practice, prevention rates remain inadequate in many centres.
To evaluate the effectiveness of different strategies aimed at improving adherence to adequate VTE prophylaxis in surgical patients at high risk of VTE.
Before and after intervention study conducted at a tertiary hospital. Adherence to adequate VTE prophylaxis was compared according to three strategies consecutively implemented from January 2019 to December 2020. A dedicated hospitalist physician alone (strategy A) or in conjunction with a nurse (strategy B) overlooked the postoperative period to ensure adherence and correct inadequacies. Finally, a multidisciplinary team approach (strategy C) focused on promoting adequate VTE prophylaxis across multiple stages of care-from the operating room (ie, preoperative team-based checklist) to collaboration with clinical pharmacists in the postoperative period-was implemented.
We analysed 2074 surgical patients: 783 from January to June 2019 (strategy A), 669 from July 2019 to May 2020 (strategy B), and 622 from June to December 2020 (strategy C). VTE prophylaxis adherence rates for strategies (A), (B) and (C) were (median (25th-75th percentile)) 43.29% (31.82-51.69), 50% (42.57-55.80) and 92.31% (91.38-93.51), respectively (p<0.001; C>A=B). There was a significant reduction in non-compliance on all analysed criteria (risk stratification (A (25.5%), B (22%), C (6%)), medical documentation (A (68%), B (55.2%) C (9%)) and medical prescription (A (51.85%), B (48%), C (6.10%)) after implementation of strategy C (p<0.05). Additionally, a significant increase in compliance with adequate dosage, dosing interval and scheduling of the prophylactic regimen was observed.
Perioperative VTE prophylaxis strategies that relied exclusively on physicians and/or nurses were associated with suboptimal execution and prevention. A multidisciplinary team-based approach that covers multiple stages of patient care significantly increased adherence to adequate VTE prophylaxis in surgical patients at high risk of developing perioperative VTE.
静脉血栓栓塞症（VTE）是围手术期发病率和死亡率的主要原因。尽管在推进循证实践方面做出了重大努力，但在许多中心，预防率仍然不足。
评估旨在提高高危 VTE 手术患者接受适当 VTE 预防的不同策略的有效性。
在一家三级医院进行的干预前后研究。根据从 2019 年 1 月至 2020 年 12 月连续实施的三种策略，比较了术后适当 VTE 预防的依从性。单独（策略 A）或与护士一起（策略 B）使用专门的医院医生来监督术后期间的依从性并纠正不足。最后，实施了多学科团队方法（策略 C），重点是在围手术期的多个阶段促进适当的 VTE 预防-从手术室（即术前基于团队的检查表）到与术后临床药师合作。
我们分析了 2074 名手术患者：2019 年 1 月至 6 月期间为 783 名（策略 A），2019 年 7 月至 2020 年 5 月期间为 669 名（策略 B），2020 年 6 月至 12 月期间为 622 名（策略 C）。策略（A）、（B）和（C）的 VTE 预防依从率分别为（中位数（25 至 75 百分位数））43.29%（31.82-51.69）、50%（42.57-55.80）和 92.31%（91.38-93.51）（p<0.001；C>A=B）。在所有分析的标准中，非依从性都有显著减少（风险分层（A（25.5%），B（22%），C（6%）），医疗文件（A（68%），B（55.2%）C（9%））和医疗处方（A（51.85%），B（48%），C（6.10%））在实施策略 C 后（p<0.05）。此外，还观察到适当剂量、给药间隔和预防方案的安排的依从性显著增加。
仅依靠医生和/或护士的围手术期 VTE 预防策略与执行和预防效果不佳有关。多学科团队方法覆盖患者护理的多个阶段，显著提高了高危发生围手术期 VTE 的手术患者接受适当 VTE 预防的依从性。
