The implementation of nice guidance on venous thromboembolism risk assessment and prophylaxis: a before-after observational study to assess the impact on patient safety across four hospitals in England

Bateman, Alice G., Sheaff, Rod, Child, Susan, Boiko, Olga, Ukoumunne, Obioha C., Nokes, Tim, Copplestone, Adrian and Gericke, Christian A. (2013) The implementation of nice guidance on venous thromboembolism risk assessment and prophylaxis: a before-after observational study to assess the impact on patient safety across four hospitals in England. Bmc Health Services Research, 13 1: 203.1-203.7. doi:10.1186/1472-6963-13-203


Author Bateman, Alice G.
Sheaff, Rod
Child, Susan
Boiko, Olga
Ukoumunne, Obioha C.
Nokes, Tim
Copplestone, Adrian
Gericke, Christian A.
Title The implementation of nice guidance on venous thromboembolism risk assessment and prophylaxis: a before-after observational study to assess the impact on patient safety across four hospitals in England
Journal name Bmc Health Services Research   Check publisher's open access policy
ISSN 1472-6963
Publication date 2013-06
Year available 2013
Sub-type Article (original research)
DOI 10.1186/1472-6963-13-203
Open Access Status DOI
Volume 13
Issue 1
Start page 203.1
End page 203.7
Total pages 7
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2014
Language eng
Formatted abstract
Background
Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalised patients. VTE prevention has been identified as a major health need internationally to improve patient safety. A National Institute for Health and Clinical Excellence (NICE) guideline was issued in February 2010. Its key priorities were to assess patients for risk of VTE on admission to hospital, assess patients for bleeding risk and evaluate the risks and benefits of prescribing VTE prophylaxis.
The aim of this study was to evaluate the implementation of NICE guidance and its impact on patient safety.
Methods
A before-after observational design was used to investigate changes in VTE risk assessment documentation and inappropriate prescribing of prophylaxis between the year prior to (2009) and the year following (2010) the implementation of NICE guidance, using data from a 3-week period during each year. A total of 408 patients were sampled in each year across four hospitals in the NHS South region.
Results
Implementation strategies such as audit, education and training were used. The percentage of patients for whom a VTE risk assessment was documented increased from 51.5% (210/408) in 2009 to 79.2% (323/408) in 2010; difference 27.7% (95% CI: 21.4% to 33.9%; p < 0.001). There was little evidence of change in the percentage who were prescribed prophylaxis amongst patients without a risk assessment (71.7% (142/198) in 2009 and 68.2% (58/85) in 2010; difference −3.5% (95% CI: -15.2% to 8.2%; p =0.56) nor the percentage who were prescribed low molecular weight heparin amongst patients with a contraindication (14% (4/28) in 2009 and 15% (6/41) in 2010; RD = 0.3% (95% CI: -16.5% to 17.2%; p =0.97).
Conclusions
The documentation of risk assessment improved following the implementation of NICE guidance; it is questionable, however, whether this led to improved patient safety with respect to prescribing appropriate prophylaxis.
Keyword Venous thromboembolism (VTE)
Implementation strategies
Nice
Patient safety
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
 
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