Thromboprophylaxis in Intensive Care: A Nationwide, Multidisciplinary Quality Improvement Project

Abstract

Patients admitted to intensive care units (ICUs) are at high risk of developing venous thromboemboli. Pharmacological thromboprophylaxis is efficacious in critically ill patients; however, prescription of such agents is often found to be suboptimal. The aim of this study was to assess the quality of pharmacoprophylaxis prescribing across Scottish ICUs, and to introduce measures to improve this. A point-prevalence survey of thromboprophylaxis was followed by a pharmacist-delivered intervention and a subsequent point-prevalence survey, in 22 Scottish ICUs. In the initial survey, 15% of eligible patients (n=94) were not receiving pharmacoprophylaxis, while 10% of ineligible patients had thromboprophylaxis prescribed. A quality improvement programme was instituted with pharmacist-delivered daily checks for thromboprophylaxis prescription, prompting of medical staff and local checklists. Following implementation of the intervention, a repeat survey of 130 patients revealed that the rate of eligible patients receiving thromboprophylaxis rose to 96%, (p=0.02, relative risk reduction 0.89). Additionally mechanoprophylaxis use increased and those receiving no prophylaxis fell to 8% (p=0.005 relative risk reduction 0.85). The rate of prescription of thromboprophylaxis to ineligible patients was 14% (p=0.65). A simple intervention led to significant improvements in the use of thromboprophylaxis in ICU, with an effect achievable on a national scale.