Sticker reminders improve thromboprophylaxis appropriateness in hospitalized patients

Abstract 

Background

Venous thromboembolism (VTE) is a major health problem. Even though effective thromboprophylaxis measures exist to prevent VTE, close adherence to guidelines is missing. We assessed the effects of pasting VTE prophylaxis sticker reminders, on the appropriateness of thromboprophylaxis and prophylaxis underutilization.

Methods

Thromboprophylaxis reception was sought prospectively in two time points before and two time points after pasting sticker reminders in hospitalized patients of Masih Daneshvari Medical Center, Tehran, Iran. Thromboprophylaxis reception appropriateness was evaluated by the eighth American College of Chest Physicians (ACCP) guidelines on antithrombotic and thrombolytic therapy. Co-morbidities and conditions considered to affect the risk of venous thromboembolism were also recorded.

Results

Prophylaxis reception and appropriateness were studied in 298 patients before and 306 patients after the intervention. Based on the ACCP guidelines, overall thromboprophylaxis appropriateness was improved after the intervention (70.4% before, and 78.1% after the intervention, P=0.03). Prophylaxis underutilization, and prophylaxis initiation delay in those who needed thromboprophylaxis, were also reduced (P=0.03, and P=0.011 respectively). The intervention did not result in an increased rate of overprophylaxis (P=0.45).

Conclusion

Sticker reminders could be safely and effectively incorporated into strategies to improve VTE prophylaxis and prophylaxis appropriateness, particularly in healthcare settings where electronic alert systems are not available.

Abbreviations: ACCP, American College of Chest Physicians, COPD, chronic obstructive pulmonary disease, HF, heart failure, HIV, human immunodeficiency viurs, ICU, intensive care unit, NRITLD, National Research Institute of Tuberculosis and Lung Disease, SE, standard error of the mean, TB, tuberculosis, VTE, venous thromboembolism

Keywords: Appropriateness, Prophylaxis, Sticker reminder, Thromboprophylaxis, Venous thromboembolism