Study on the suitability of prophylaxis of venous thromboembolism in patients in surgical units of Hospital das Clínicas da Faculdade de Medicina de Botucatu-Unesp.

Abstract

Summary Venous thromboembolism (VTE) is an usual and potentially preventable cause of morbidity and mortality in hospitalized patients, which causes a large proportion of fatal pulmonary embolism in this population. Studies of hospitalized patients show low rates of prophylaxis according to international guidelines. Lack and insufficient duration of prophylaxis are the most common causes of inadequate prophylaxis. An international study showed that considering a total of 196,104 patients from 227 hospitals, the overall rate of VTE prophylaxis was 61.8%, although the rate of appropriate use was only 33.9%. Analyzing the patients who have not received it properly, 38.4% received no prophylaxis, 4.7% received only mechanical prophylaxis, 6.3% received an inadequate dose and 16.7% received prophylaxis during inadequate period, based on the ACCP's recommendations. In cross-section study in four public and private hospitals in Salvador, 226 consecutive clinical patients were analyzed and only one third of potential candidates for prevention of VTE prophylaxis received properly. VTE prevention is currently an international hospitals initiative, with focus on prevention quality. Multiple strategies have been used mainly active interventions such as education and active reminders to the prescribers (electronic alerts, computer programs), regular audits and information reports to medical staff, and the passive, as the consensus spread. It is going to be evaluated if the use of venous thromboembolism prophylaxis is correct / appropriate or not, related to the risk classification for each patient, according to a specific protocol based on hospital prescriptions data and medical records concerning to the current hospitalization . Objectives The main objective is to evaluate the adequacy of venous thromboembolic disease prophylaxis used in hospitalized patients at surgical units of the Hospital das Clínicas da Faculdade de Medicina de Botucatu-Unesp.Detailed Description Cross-section of hospitalized patients at surgical units of the Hospital das Clínicas da Faculdade de Medicina de Botucatu-Unesp.From the results of this survey, we intend to initiate educational policy guidance, supervision and training of students, doctors, nurses and physiotherapists about the identification and recognition of risk factors for venous thromboembolic disease, but also educate them to perform the individual risk categorization, applying a suitable prophylaxis method for each patient, trying to decrease the risk of thromboembolic complications in patients at the Hospital das Clinicas, Faculdade de Medicina de Botucatu - UNESP. Deployment of the study Train the medical staff (doctors, nurses, physical therapists, graduate students, pharmacists) for monitorization and evaluation of hospitalized patients to identify potential risk of thromboembolic disease, as well as the orientation to the appropriate prophylaxis individually according to risk categorization.After its implementation, we intend to perform periodic surveys in patients, in order to verify the adequacy of prophylaxis and to evaluate the impact and effectiveness of an educational policy through posters, "folders", classes, symposia and systematic visits of patients admitted by the members.