INCREASING HIGH-VALUE VENOUS THROMBOEMBOLISM PROPHYLAXIS: A WIN-WIN SITUATION

Purpose:  Low molecular weight heparin (LMWH) is an effective means of preventing venous thromboembolism (VTE) among medical inpatients.  When compared to unfractionated heparin, LMWH has been shown to be superior in terms of efficacy, risk of bleeding and cost.  Despite its numerous advantages, LMWH is used infrequently as VTE prophylaxis for general medicine patients at Mayo Clinic Hospital.  Thus, a quality improvement (QI) project was undertaken to increase the use of LMWH for VTE prophylaxis among the census of medical patients hospitalized on resident teaching services between April and August 2015.

Method(s):  A QI team was formed; it consisted of resident and attending physicians with nursing and pharmacy leadership.  A systems analysis was performed, where stakeholder interviews revealed prescriber knowledge as the greatest barrier to LMWH utilization.  Several Plan-Do-Study-Act (PDSA) cycles were executed, featuring interventions such as peer-to-peer education, pharmacist-to-resident education, performance feedback, educational posters and emails.    

Result(s):  Data analysis demonstrated a statistically significant increase in LMWH use among hospitalized medical patients by 66.3% following the implementation of the interventions (p<0.001).  

Conclusion(s):  Peer-to-peer education and feedback resulted in some improvement, but pharmacist education elicited the largest practice change.  In an effort to promote sustainability, a recurring pharmacist-led educational session has been implemented into new resident orientation.

   Sustained over a one-month period, this improvement conserves over 450 injections and nearly 80 total hours of nursing time.  The use of LMWH for VTE prophylaxis rather than unfractionated heparin improves patient satisfaction, quality, cost and efficiency of healthcare – it is a ‘win’ for nursing staff, providers, and most of all patients.