Comparison of strategies for adherence to venous thromboembolism prophylaxis in high-risk surgical patients: a before and after intervention study

Figures

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  Figure 1. Diagram showing eligibility, inclusion criteria and distribution of patients according to three strategies ((A), (B) and (C)) consecutively implemented between January 2019 and December 2020 aimed to improve adherence to adequate venous thromboembolism (VTE) prophylaxis in surgical patients at high risk of perioperative VTE.

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  Figure 2. Run chart and statistical process control chart showing quality improvement regarding adherence to venous thromboembolism (VTE) pharmacological prophylaxis in patients at high risk of developing perioperative VTE from January 2019 to December 2020. Three strategies ((A), (B) and (C)) aimed to improve adherence were consecutively implemented during this historical series. A dedicated hospitalist physician alone (strategy A) who subsequently worked in conjunction with a nurse (strategy B) actively overlooked the postoperative period to ensure adherence and correct inadequacies. Finally, a multidisciplinary team (including active involvement of clinical pharmacists) overlooked multiple stages of patient care to ensure/promote optimal prophylaxis (strategy C). Dashed lines (run chart) represent the median adherence to VTE pharmacological prophylaxis according to each strategy within the respective time period that they were in effect. LCL, lower control limit; UCL, upper control limit; x¯, mean (control chart).

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  Figure 3. Run chart and statistical process control chart showing quality improvement regarding adherence to venous thromboembolism (VTE) mechanical prophylaxis in patients at high risk of developing perioperative VTE from January 2019 to December 2020. Three strategies ((A), (B) and (C)) aimed to improve adherence were consecutively implemented during this historical series. A dedicated hospitalist physician alone (strategy A) who subsequently worked in conjunction with a nurse (strategy B) actively overlooked the postoperative period to ensure adherence and correct inadequacies. Finally, a multidisciplinary team (including active involvement of clinical pharmacists) overlooked multiple stages of patient care to ensure/promote optimal prophylaxis (strategy C). Dashed lines (run chart) represent the median adherence to VTE mechanical prophylaxis according to each strategy within the respective time period that they were in effect. Mechanical prophylaxis was not included as part of our adherence/compliance criteria for perioperative VTE prophylaxis. LCL, lower control limit; UCL, upper control limit; x¯, mean (control chart).

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  Figure 4. Adherence to venous thromboembolism (VTE) prophylaxis in patients at high risk of developing perioperative VTE was compared according to strategies consecutively implemented from January 2019 to December 2020. Box-plot: median (percentile 25%–75%). Strategy (A): a dedicated hospitalist physician overlooked the postoperative period to ensure adherence; strategy (B): a dedicated team (hospitalist physician in conjunction with a nurse) overlooked the postoperative period to ensure adherence; strategy (C): a multidisciplinary team (including active involvement of clinical pharmacists) overlooked multiple stages of patient care to ensure/promote adherence to prophylaxis. *Kruskal-Wallis: p<0.001; Dunn’s post-hoc test: C>A and B; A=B.

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  Figure 5. Interventions by clinical pharmacists to ensure adherence to adequate perioperative venous thromboembolism (VTE) prophylaxis after implementation of strategy (C) (June–December 2020). The black line represents the percentage (%) of patients requiring intervention by clinical pharmacists in relation to the total number of postoperative patients at high risk of developing perioperative VTE. The bars represent a monthly breakdown of whom (surgeon vs nurse) the interventions by clinical pharmacists were directed to.