The use of prophylaxis to prevent venous thromboembolism (VTE) has steadily increased over the past decade, with a recent audit determining that 86 per cent of patients in Canadian hospitals are receiving the appropriate prophylaxis to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). The Canadian Venous Thromboembolism (VTE) Audit was held during October 2014 to establish a national perspective of VTE thromboprophylaxis rates and raise awareness of appropriate VTE prophylaxis.
“There was broad representation from across the country and in the volume of patients audited to obtain a national snapshot of prophylaxis use,” says Dr. Bill Geerts, National Lead for the Safer Healthcare Now! Venous Thromboembolism intervention. “It is pretty gratifying to see improvement in the use of prophylaxis; however of significant note is that 14 per cent of patients at risk for VTE did not receive the appropriate prophylaxis.”
The national VTE audit included data from 3,809 general medicine and general surgery patients from 110 sites across the country. In 2013, data was analyzed for 4,667 general medicine and general surgery patients from 118 sites in Canada, with 81 per cent receiving the appropriate prophylaxis.
Southlake Regional Health Centre in Newmarket, Ontario had the pharmacist group collect data for the VTE audit at their site. “The process was embedded into the pharmacist’s work and we selected one day to input data using the Patient Safety Metrics tool,” says Patti Ferguson, Pharmacy Manager. “Our results were impressive with 94 percent appropriateness. This is an improvement for us and I would attribute much of that improvement to our robust implementation of standardized order sets”
The national VTE audit analyzed the impact of using preprinted order sets, finding that appropriate thrombolytic was administered in 94 per cent of patients when order sets were used, compared to 78 per cent of patients when order sets were not used. Order sets were used in 51 per cent of general medicine patients and 46 per cent of general surgery patients. “The use of prophylaxis is solidly entrenched in evidence and relatively simple to administer,” says Dr. Geerts. “If you embed safety principles into order sets, it makes the whole process so much simpler to administer.”
The audit also confirmed the type of prophylaxis used most often (60 per cent of the time) is low dose molecular heparin (LDMH), followed by low dose heparin (LDH), which was administered 27 per cent of the time. Reasons for not using a thrombolytic when indicated included no thromboprophylaxis ordered (73 per cent), delay in start (8 per cent), wrong dose (6 per cent) and modality variation from the Safer Healthcare Now! recommendation (7 per cent).
Click here to download the VTE Audit results and provincial comparisons. For more information on the VTE Audit, visit www.saferhealthcarenow.ca