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A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines

Background Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is...

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Autores principales: Jaspers, Tessa, Duisenberg-van Essenberg, Marjolijn, Maat, Barbara, Durian, Marc, van den Berg, Roy, van den Bemt, Patricia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460504/
https://www.ncbi.nlm.nih.gov/pubmed/33709383
http://dx.doi.org/10.1007/s11096-021-01254-x
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author Jaspers, Tessa
Duisenberg-van Essenberg, Marjolijn
Maat, Barbara
Durian, Marc
van den Berg, Roy
van den Bemt, Patricia
author_facet Jaspers, Tessa
Duisenberg-van Essenberg, Marjolijn
Maat, Barbara
Durian, Marc
van den Berg, Roy
van den Bemt, Patricia
author_sort Jaspers, Tessa
collection PubMed
description Background Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low. Objective To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented. Setting A Dutch general teaching hospital. Method A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients. Main outcome measure Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements. Results 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4 to 82.4% (OR 4.78; 95%CI 2.37–9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5 to 84.3% (OR 2.46; 95%CI 1.31–4.62), resulting in the potential prevention of ± 261 venous thromboembolisms per year. Conclusions Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence.
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spelling pubmed-84605042021-10-07 A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines Jaspers, Tessa Duisenberg-van Essenberg, Marjolijn Maat, Barbara Durian, Marc van den Berg, Roy van den Bemt, Patricia Int J Clin Pharm Research Article Background Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low. Objective To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented. Setting A Dutch general teaching hospital. Method A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients. Main outcome measure Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements. Results 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4 to 82.4% (OR 4.78; 95%CI 2.37–9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5 to 84.3% (OR 2.46; 95%CI 1.31–4.62), resulting in the potential prevention of ± 261 venous thromboembolisms per year. Conclusions Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence. Springer International Publishing 2021-03-11 2021 /pmc/articles/PMC8460504/ /pubmed/33709383 http://dx.doi.org/10.1007/s11096-021-01254-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research Article
Jaspers, Tessa
Duisenberg-van Essenberg, Marjolijn
Maat, Barbara
Durian, Marc
van den Berg, Roy
van den Bemt, Patricia
A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines
title A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines
title_full A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines
title_fullStr A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines
title_full_unstemmed A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines
title_short A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines
title_sort multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460504/
https://www.ncbi.nlm.nih.gov/pubmed/33709383
http://dx.doi.org/10.1007/s11096-021-01254-x
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