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. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

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 SafetyIn 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. Mark your calendars to attend the Annual Scientific Assembly of Southern Medical Association, December 3-5, 2009 at the Gaylord Texan Resort and Convention Center in Dallas, Texas. For additional information, call 800-423-4992, ext. 620 or visit http://www.sma.org/am2009

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