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Improved Compliance With Venous Thromboembolism Pharmacologic Prophylaxis for Patients With Gynecologic Malignancies Hospitalized for Nonsurgical Indications Did Not Reduce Venous Thromboembolism Incidence
  1. Lauren S. Prescott, MD*,
  2. Lisa M. Kidin, MHA, MSN,
  3. Rebecca L. Downs, BS,
  4. David J. Cleveland, BA§,
  5. Ginger L. Wilson, MPH, PharmD,
  6. Mark F. Munsell, MS,
  7. Alma Y. DeJesus, MSN,
  8. Katherine E. Cain, PharmD,
  9. Pedro T. Ramirez, MD*,
  10. Michael H. Kroll, MD#,
  11. Charles F. Levenback, MD* and
  12. Kathleen M. Schmeler, MD*
  1. *Departments of Gynecologic Oncology and Reproductive Medicine,
  2. Performance Improvement,
  3. Diagnostic Imaging,
  4. §Clinical Effectiveness,
  5. Pharmacy,
  6. Biostatistics, and
  7. #Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX.
  1. Address correspondence and reprint requests to Kathleen M. Schmeler, MD, Department of Gynecologic Oncology and Reproductive Medicine, Unit 1362, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. E-mail: kschmele{at}mdanderson.org.

Abstract

Objective National guidelines recommend prophylactic anticoagulation for all hospitalized patients with cancer to prevent hospital-acquired venous thromboembolism (VTE). However, adherence to these evidence-based recommended practice patterns remains low. We performed a quality improvement (QI) project to increase VTE pharmacologic prophylaxis rates among patients with gynecologic malignancies hospitalized for nonsurgical indications and evaluated the resulting effect on rates of development of VTE.

Materials and Methods In June 2011, departmental VTE practice guidelines were implemented for patients with gynecologic malignancies who were hospitalized for nonsurgical indications. A standardized VTE prophylaxis module was added to the admission electronic order sets. Outcome measures included number of admissions receiving VTE pharmacologic prophylaxis within 24 hours of admission; and number of potentially preventable hospital-acquired VTEs diagnosed within 30 and 90 days of discharge. Outcomes were compared between a preguideline implementation cohort (n = 99), a postguideline implementation cohort (n = 127), and a sustainability cohort assessed 2 years after implementation (n = 109). Patients were excluded if upon admission they had a VTE, were considered low risk for VTE, or had a documented contraindication to pharmacologic prophylaxis.

Results Administration of pharmacologic prophylaxis within 24 hours of admission increased from 20.8% to 88.2% immediately following the implementation of guidelines, but declined to 71.8% in our sustainability cohort (P < 0.001). There was no difference in VTE incidence among the 3 cohorts [n = 2 (4.2%) vs n = 3 (3.9%) vs n = 3 (4.2%), respectively; P = 1.00].

Conclusions Our QI project improved pharmacologic VTE prophylaxis rates. A small decrease in prophylaxis during the subsequent 2 years suggests a need for continued surveillance to optimize QI initiatives. Despite increased adherence to guidelines, VTE rates did not decline in this high-risk population.

  • Venous thromboembolism
  • Gynecologic cancer
  • Quality improvement
  • Patient safety
  • Guidelines

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Footnotes

  • This work was supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant (P30 CA016672).

  • Michael H. Kroll is a member of Scientific Advisory Board of Aplagon Therapeutics. Ginger L. Wilson is currently working as a Pfizer employee.

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