Designing and implementing effective venous thromboembolism prevention protocols: lessons from collaborative efforts.
Designing and implementing effective venous thromboembolism prevention protocols: lessons from collaborative efforts.
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DOI：
10.1007/s11239-009-0405-4
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发表时间：
2010-02
影响因子：
4
通讯作者：
Stein J
中科院分区：
文献类型：
--
作者：
Maynard G;Stein J
医院获得性静脉血栓栓塞 (VTE) 是发病率和死亡率的主要来源，但行之有效的预防措施往往没有得到充分利用。缺乏经过验证的 VTE 风险评估模型、难以将 VTE 风险评估和预防方案整合到常规护理过程中以及缺乏 VTE 预防的标准化指标都是障碍。最近，VTE 风险评估/预防方案已得到验证，导致便携式策略在各种住院环境中实现了突破性的充分预防水平。 VTE 预防方案的设计和实施策略已收集在医院医学协会和医疗保健研究与质量机构提供的实施指南中。这些指南是涉及 150 多个医疗中心的国家协作努力改善 VTE 的核心内容，完善了本文所述的加速改善的方法。将 VTE 预防方案嵌入入院、转院和围手术期医嘱集中是一项关键策略。 VTE 预防方案被定义为不超过三个风险级别的 VTE 风险评估，与每个级别的推荐预防措施紧密相关。必须保持提供方案指导的需要与临床医生对效率和易用性的需要之间的平衡。这种协议驱动方法的力量得到了质量改进框架、多学科团队、对流程的持续监控以及通过测量进展和提示并发干预的技术（我们称之为“测量预防”的方法）实时识别和缓解不遵守者的支持。
Hospital acquired venous thromboembolism (VTE) is a major source of morbidity and mortality, yet proven prevention measures are often underutilized. The lack of a validated VTE risk assessment model, difficulty integrating VTE risk assessment and prevention protocols into the routine process of care, and the lack of standardized metrics for VTE prophylaxis have all been barriers. Recently, a VTE risk assessment/prevention protocol has been validated, leading to portable strategies achieving breakthrough levels of adequate prophylaxis in a variety of inpatient settings. VTE prevention protocol design and implementation strategies have been collected in implementation guides available from the Society of Hospital Medicine and the Agency for Healthcare Research and Quality. These guides were the centerpieces of national collaborative efforts to improve VTE involving over 150 medical centers, honing the approach to accelerate improvement described in this article. Embedding a VTE prevention protocol into admission, transfer, and perioperative order sets is a key strategy. A VTE prevention protocol is defined as a VTE risk assessment with no more than three levels of risk, tightly linked to recommended prophylaxis for each level. A balance between the need to provide protocol guidance and the need for efficiency and ease-of-use by the clinician must be maintained. The power of this protocol driven approach is bolstered by a quality improvement framework, multidisciplinary teams, ongoing monitoring of the process, and real time identification and mitigation of non-adherents via a technique that measures progress and prompts concurrent intervention, an approach we call “measure-vention.”
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