Background VTE is a public health problem; the prevention of VTE is a strategy to improve patient safety. In Portugal 53 percent of HMPs are at risk of VTE and preventive measures are in place for only 59 percent of them.
Purpose To assess the risk of VTE in HMPs based on risk factors (RF), to analyse the prescription of LMWH, to determine the number of patients (a) with prescriptions without RF/contraindicated (CI), (b) without prescriptions with RF, (c) with an unadjusted dose, (d) with prescriptions and RF (e) without prescriptions or RF/CI. To evaluate the need to develop a VTE Risk Assessment Model (RAM).
Material and methods HMPs in three services were studied over 2 months. Patients with anticoagulants at therapeutic doses were excluded. Medical records were consulted to find RF. Patients were classified according to the Cohen RAM and according to the prescription of LMWH. Physicians were consulted. Pharmaceutical intervention and medical justification were recorded.
Results Of all patients (141), 67.4% were classed as having RF for VTE; 56.7% had received prophylaxis with LMWH. Patients were classified in (a) 9.2%, (b) 19.9%, (c) 2.1%, (d) 45.4% and (e) 23.4%. Pharmaceutical interventions were made in 31.2% of prescriptions, prescriptions were changed in only 3.6%. Age factor >75 years (44.7%), active cancer requiring treatment (23.4%) and acute infection (18.4%) were the three most common RF.
Conclusion Of patients who are not treated prophylactically (30%), a large number is due to the lack of consensus in relation to VTE prophylaxis in cancer patients, sick patients with dementia and patients in palliative care.
As clinicians do not follow a RAM for VTE, the need to develop a consensual model has been identified.
Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices
Reis A, Rocha N, et al. Guidelines for the prevention, diagnosis and treatment of venous thromboembolism in the medical patient
ReferencesNo conflict of interest.
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