Prophylaxis of thromboembolic disease: patient safety protocoL

Critically ill patients have a high risk of deep venous thrombosis and pulmonary embolism, which comprise venous thromboembolic disease (VTED). Prevention during critical illness is a widely used quality metric and safety initiative for these patients.

To evaluate the effectiveness of a bundle of VTED prophylactic measures upon completion of a project aim to improve patient safety in this entity.

We designed a three phases prospective study of patients admitted to a general ICU of a tertiary university hospital. During first 4 months, weekly collection days are established, gathering demographic variables, reason for admission, severity scores, risk factors for hemorrhage and thrombosis as well as VTED prophylactic measures prescribed. Data were analyzed using a Failure Mode and Effects Analysis (FMEA) from which a set of measures were developed and the implementation of a VTED prophylaxis protocol. After that, we collected data during 5 months to compare the effectiveness of the protocol. Finally, a checklist was introduced to facilitated the adherence to these measures. The impact of this checklist was evaluated for 2 more months. All results were analyzed using the SPSS v22.0.0 statistical analysis software.

In the first period we enrolled 59 patients, 42 of them (71.2%) received prophylaxis for VTE (63.4% had pharmacological prophylaxis and 34.1% mechanical) and 2.4% received dual prophylaxis. Seventeen patients (28.8%) received no prophylaxis, 2 of them had contraindication to any type of VTED thromboprophylaxis.

Post-FMEA, we enrolled 97 patients, 89 of them (91.7%) received prophylaxis for VTED: 55% received pharmacological prophylaxis and 45% mechanical devices. Dual prophylaxis was received by 6.25% of patients. From those who received mechanical devices, 67.9% received compression stockings. Seven patients (8.2%) presented high risk of bleeding and did not receive prophylaxis. One patient had contraindication for both types of measures.

Post checklist we included 40 patients, 39 of them (97.5%) of them received prophylactic measures: 73.5% received pharmacological prophylaxis and 32.5% mechanical devices. Dual prophylaxis were applied in 25% of patients. Only 1 patient (2.5%) had double contraindication for VTED measures.

The number of patients with high risk of thrombosis as well as those who receive dual prophylaxis has increased after the implemetation of a VTED prophylaxis protocol. The development of a daily checklist could be a useful tool to monitor adherence to this protocol. All of these measures are expected to improve patient safety.

Affiliations

1. 12 de Octubre University Hospital, Intensive Care Medicine Department. Medical Intensive Care Unit, Madrid, Spain

   • R Viejo Moreno
   • , M Talayero Giménez de Azcárate
   • , J Barea Mendoza
   • , H Domínguez Aguado
   • , N Regueiro Díaz
   • , L Díaz Castellano
   • , M Castillo Jaramillo
   • , LJ Terceros Almanza
   • , S Temprano Vázquez
   • , J Á Sánchez-Izquierdo Riera
   •  & JC Montejo González

Corresponding author

Correspondence to R Viejo Moreno.

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