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Checklist
improves prevention of dangerous Blood Clots
in Hospital Patients
Newswise — For hospitalized patients, a simple checklist
can encourage the use of recommended
treatments to prevent a serious complication
called venous thromboembolism (VTE), reports
a study in the December Southern Medical
Journal, official journal of the
Southern Medical Association.
Led by Glenn Clinton Shedd, FNP, DNP, of Athens (Ga.)
Regional Medical Center, the researchers
developed a checklist to assess risk factors
for VTE.
Based on a previously published Thrombosis Risk Assessment
Tool, the checklist provided a quick way to
calculate a VTE risk factor score for
hospitalized patients.
Each individual patient's risk score was used to recommend
specific treatments to prevent VTE—ranging
from mechanical measures like elastic
stockings to anti-clotting medications like
heparin.
Simple VTE Checklist Results in Improved Safety
In a preliminary study, the researchers
found that patients hospitalized for
"medical" problems—as opposed to those
admitted for surgery—had a particularly low
rate of appropriate preventive treatments
(prophylaxis) for VTE.
Nearly half of medical patients did not receive recommended
VTE prophylaxis.
In contrast, most patients undergoing general or orthopedic
surgery did receive appropriate preventive
measures.
(Major surgery such as hip or knee replacement is a strong
risk factor for VTE, and should almost
always lead to prophylaxis.)
Dr. Shedd and colleagues focused on using the checklist to
increase the use of appropriate VTE
prophylaxis in medical patients.
For 74 consecutive patients, the researchers placed a
completed checklist noting the VTE risk
score in each patient's chart.
The checklist was accompanied by a blank physician's order
form noting the appropriate preventive
measures for patients at each level of risk.
The checklist dramatically increased the use
of recommended treatments to prevent VTE.
The percentage of patients receiving
appropriate VTE prophylaxis increased to
over 75 percent, compared to about 40
percent before the checklist was used.
Even more important, the use of the checklist more than
doubled the patient's chances of receiving
at least some type of preventive treatment.
In fact, with the use of the checklist,
medical patients were more likely to receive
prophylaxis than surgical patients.
A VTE is a clot that develops in the veins, which can lead
to serious problems like poor blood
circulation in the legs (deep vein
thrombosis) or blockage of the arteries
leading to the lungs (pulmonary embolism).
Assessing VTE risk is an important part of
care for hospitalized patients.
However, patients don't always receive recommended care to
prevent VTE, including some who would be
considered at high risk under current
guidelines.
The new checklist "quantifies risk of VTE and identifies
appropriate prophylaxis regimens for
different levels of risk," Dr. Shedd and
colleagues conclude.
In an accompanying editorial, Dr. Jeffrey B. Hoag of Drexel
University College of Medicine writes, "This
is yet another example of a tool to increase
adherence to guidelines that leads to a
dramatic improvement in appropriate
physician care."
Dr. Hoag emphasizes the need for hospitals to develop
"system-level" measures to increase the
percentage of patients receiving care
consistent with the recently-updated
guidelines for VTE prevention.
About the Southern
Medical Journal
The Southern Medical Journal (http://www.smajournalonline.com)
is published monthly by the Southern Medical
Association and Lippincott Williams &
Wilkins. Devoted solely to continuing
education, the Journal publishes annually
more than 200 original clinical articles
directed to the practicing physician and
surgeon on topics such as hypertension,
osteoporosis, alcoholism, obesity, dementia,
asthma, and diabetes and includes monthly
CME features.
About the Southern
Medical Association
The Southern Medical Association (SMA) (http://www.sma.org)
has been serving physicians' needs since its
inception in 1906. SMA's mission is to
promote the health of patients through
advocacy, leadership, education, and
service. For additional information, call
800-423-4992, ext. 620 or visit
http://www.sma.org/am2009
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