Venous thromboembolism prophylaxis guideline implementation is improved by nurse directed feedback and audit

This multicentre clinical audit of 15 Australian hospitals was conducted in 2007-208. The program incorporated a baseline audit to determine the proportion of patients receiving appropriate VTE prophylaxis according to best practice recommendations issued by the Australian and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism (ANZ-WP recommendations), followed by a 4-month education intervention program and a post intervention audit. The primary endpoint was to compare the proportion of patients being appropriately managed based on their risk profile between the two audits.A total of 8774 patients (audit 1; 4399 and audit 2; 4375) were included in the study, most (82.2% audit 1; and 81.0% audit 2) were high risk based on ANZ-WP recommendations. At baseline 37.9% of high risk patients were receiving appropriate thromboprophylaxis. This increased to 54.1% in the post intervention audit (absolute improvement 16%; 95% confidence interval [CI] 11.7%, 20.5%). As a result of the nurse educator program, the likelihood of high risk patients being treated according to ANZ-WP recommendations increased significantly (OR 1.96; 1.62, 2.37).Utilization of VTE prophylaxis amongst hospitalized medical patients can be significantly improved by implementation of a multifaceted educational program coordinated by a dedicated nurse practitioner.Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE) represents a major public health problem. VTE is primarily a problem in hospitalized or recently hospitalized patients. The incidence of VTE has been shown to be more than 100 times greater among hospitalized patients than those in the community[1]. In Australia, VTE is estimated to complicate 2-3 per 1000 hospital admissions, but varies widely by principle diagnosis[2]. Moreover, postmortem studies indicate that approximately 10% of all hospital deaths are attributed to PE,[3-5] making it the most common preventa