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Almarshad F, Bandy A, Alfaiz A, Alotaibi SF, Alaklabi SA, Alotaibi YF. A Multi-center Cross-Sectional Assessment of Healthcare Professionals' Knowledge, Attitudes, and Practices Toward Thromboprophylaxis. Cureus 2024; 16:e61835. [PMID: 38975560 PMCID: PMC11227341 DOI: 10.7759/cureus.61835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Background Venous thromboembolism (VTE) is a potentially avoidable condition that affects hospitalized patients. Risk stratification and preventative strategies have substantial evidence supporting their use, but reasons hinder widespread adoption, compliance, and success, explaining the continuation of VTE. Thromboprophylaxis consists of several measures that are frequently adopted to avoid the complications of VTE. The study evaluated knowledge, attitude, and practice toward using thromboprophylaxis by health professionals. Methods This multi-center cross-sectional study was carried out on health professionals involved in patient care working in various secondary and tertiary hospitals in the study region between October 2023 and February 2024. A previously published questionnaire was sent in the form of an online survey to the study participants. Fifteen, ten, and nine questions evaluated the participants' knowledge, attitude, and practice of thromboprophylaxis, respectively. The study followed the checklist for reporting results of the Internet E-survey (CHERRIES) guidelines. Frequency and percentages were calculated. Bi-variable and multi-variable logistic regression were carried out and presented as crude and adjusted odds ratios with corresponding 95% confidence intervals. A P-value of <0.05 was considered significant. Results Of the 219 participants, 115 (52.5%) and 104 (47.5%) were males and females. More than 50.7% were in the age group of >30 years, and the majority of the participants possessed a bachelor's (104 (47.5%)) degree. One hundred seventy-six (80.4%) of the study participants were working in government hospitals, and the majority (112 (51.1%)) were nurses. One hundred sixty-two (74% (67.63-79.65)), 175 (79.9% (73.98-85.01)) and 211 (96.3% (92.93)) had satisfactory knowledge, a positive attitude, and good practice regarding thromboprophylaxis, respectively. Regarding the facility characteristics, 196 (89.5%), 150 (68.5%), and 164 (74.9%) respondents agreed with the availability of a VTE prevention policy, VTE prevention consultants, and the availability of anticoagulants. Eighty (36.5%) participants responded with a 'not availability' of pneumatic compression devices. Of the 15 knowledge questions, the majority (124 (56.6%)) participants faulted the false statements regarding 'patients of DVT being symptomatic' and 119 (54.3%) on the statement that helping patients 'out of bed activity does not prevent VTE'. On multi-variable analysis, participants who were aware of having a VTE prevention policy and availability of anticoagulants were more knowledgeable with adjusted odds ratios of 5.39 (1.88-15.39) and 2.52 (1.12-5.63) respectively. Every practice domain received >90% approval ratings. Conclusions The study concludes that an overall satisfactory knowledge and positive attitude regarding thromboprophylaxis exists among the participants. The study proposes more training sessions on VTE prevention and orientation of health professionals on the availability of VTE policy guidelines and facility availability of resources for thromboprophylaxis.
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Affiliation(s)
| | - Altaf Bandy
- Community Medicine, Shaqra University, Shaqra, SAU
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Ambra N, Mohammad OH, Naushad VA, Purayil NK, Mohamedali MG, Elzouki AN, Khalid MK, Illahi MN, Palol A, Barman M, Sharif M, Chalihadan S, Punnorath A, Mostafa A, Al Hariri B, Khidir TGM, Varikkodan I. Venous Thromboembolism Among Hospitalized Patients: Incidence and Adequacy of Thromboprophylaxis - A Retrospective Study. Vasc Health Risk Manag 2022; 18:575-587. [PMID: 35912018 PMCID: PMC9333096 DOI: 10.2147/vhrm.s370344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/07/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose We aimed to determine the incidence of venous thromboembolism among hospitalized patients in Qatar as well as to analyze the adequacy of VTE assessment and prophylaxis in hospitalized patients. Design Retrospective observational study. Setting Four hospitals under Hamad Medical Corporation, Qatar. Participants Patients over the age of 18 who were hospitalized between January 2015 and December 2019 and developed venous thromboembolism during hospitalization or within a month after discharge were included. Results During the study period, 641,994 individuals were admitted to hospitals. The inclusion criteria were satisfied by 209 of them. The mean age was 51.25 years and 54.5% were males. Hypertension and diabetes mellitus were the most common comorbidities found in the overall group. The incidence of VTE was 32.55 [95% CI 28.4, 37.3] per 100,000 admission per year [0.032%]. The annual incidence was least in 2015 (17.8 per 100,000 admissions) and highest in 2018 (44.4 per 100,000 admissions). Eighty-six subjects had DVT, and 109 had PE, whereas 14 had both. And, 67.5% of the patients developed VTE during admission while, 32.5% developed within 1 month of discharge. Moreover, 22.9% of the patients with PE developed pulmonary embolism after discharge from the hospital. VTE assessment was performed on 64.7% of the patients, and 69.7% received VTE prophylaxis in accordance with guidelines. Conclusion Although the occurrence of VTE among hospitalized patients in Qatar is low, healthcare providers need additional education and knowledge of VTE assessment and prophylaxis to follow guidelines for all patients at the time of admission. Furthermore, risk assessment for VTE should be done for all patients at the time of discharge to decide on post-discharge prophylaxis so that incidence of VTE after discharge can be minimized. Future studies should focus on patients who developed VTE after discharge from the hospital as well as on various risk factors.
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Affiliation(s)
- Naseem Ambra
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Osama Hashim Mohammad
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Vamanjore A Naushad
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medicine -Qatar, Doha, Qatar.,Clinical Department, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Nishan K Purayil
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medicine -Qatar, Doha, Qatar.,Clinical Department, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Mohamed G Mohamedali
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Abdel Naser Elzouki
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medicine -Qatar, Doha, Qatar.,Clinical Department, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Memon Noor Illahi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Azeez Palol
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Manish Barman
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Muhammad Sharif
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medicine -Qatar, Doha, Qatar
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Titi MA, Alotair HA, Fayed A, Baksh M, Alsaif FAA, Almomani Z, Atallah M, Alsharif AF, Jamal AA, Amer YS. Effects of Computerised Clinical Decision Support on Adherence to VTE Prophylaxis Clinical Practice Guidelines among Hospitalised Patients. Int J Qual Health Care 2021; 33:6153904. [PMID: 33647102 DOI: 10.1093/intqhc/mzab034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/27/2021] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Venous thromboembolism (VTE) is an important patient safety concern. VTE leads to significant mortality and morbidity and a burden on healthcare resources. Despite the widespread availability of evidence-based clinical practice guidelines on VTE prophylaxis, we found that only 50.9% of our patients were receiving appropriate prophylaxis. The purpose of this study was to evaluate the impact of automation of an adapted VTE prophylaxis CPG using a clinical decision support system (the VTE-CDSS) on VTE prevention among hospitalised adult patients. DESIGN AND SETTING A quasi-experimental study (pre- and post-implementation) was conducted at a large 900-bed tertiary teaching multi-specialty hospital in Riyadh, Saudi Arabia. PARTICIPANTS The 1809 adult patients in the study included 871 enrolled during the pre-implementation stage and 938 enrolled during the post-implementation stage. INTERVENTION Multi-faceted implementation interventions were utilised, including leadership engagement and support, quality and clinical champions, staff training and education and regular audit and feedback. MAIN OUTCOME MEASURE Two rate-based process measures were calculated for each admission cohort (i.e. pre- and post-implementation): the percentage of inpatients who were assessed for VTE risk on admission and the percentage of inpatients who received appropriate VTE prophylaxis. Two outcome measures were calculated: the prevalence of hospital-acquired VTE (HA-VTE) events and the in-hospital all-cause mortality. RESULTS The percentage of inpatients risk assessed for VTE on admission increased from 77.4% to 93.3% (P < 0.01). The percentage of patients who received appropriate VTE prophylaxis increased from 50.9% to 81.4% (P < 0.01). The HA-VTE events decreased by 50% from 0.33% to 0.15% (P < 0.01).All-cause in-hospital mortality did not significantly change after implementation of the VTE-CDSS compared with pre-implementation mortality (P > 0.05). CONCLUSION The VTE-CDSS improved patient safety by enhancing adherence to the VTE prophylaxis best practice and adapted CPG. The multi-faceted implementation strategies approach improved the compliance rate of risk assessment and the adherence to prophylaxis recommendations and substantially reduced the HA-VTE prevalence. A successful CDSS requires a set of critical components to ensure better user compliance and positive patient outcomes.
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Affiliation(s)
- Maher A Titi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Hadil A Alotair
- Division of Pulmonary and Critical Care, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Amel Fayed
- College of Medicine, Clinical Department, Princess Nora Bint Abdulrahman University, Riyadh 11671, Saudi Arabia.,High Institute of Public Health, Alexandria University, 165 El-Horeya Road, El-Ibrahimia Qebli wa El-Hadarah Bahari, Qism Bab Sharqi, Alexandria Governorate, Alexandria 165, Egypt
| | - Maram Baksh
- Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Faisal Abdullah Abdulaziz Alsaif
- Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Ziad Almomani
- Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Mohammad Atallah
- Nursing Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Asrar F Alsharif
- Information Technology Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Amr A Jamal
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Department of Family and Community Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Yasser S Amer
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, New University Hospital, Alexandria University, Alexandria 21131, Egypt
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