ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 39-43

Effect of academic detailing on improvement in venous thromboembolism prophylaxis for critically ill and surgical patients in a tertiary care teaching hospital


1 Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
2 Department of Surgery, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India
3 Department of Critical Care, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India

Correspondence Address:
Dr. Bijoy Kumar Panda
Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_35_19

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Background: Routine utilization of venous thromboembolism (VTE) risk assessment tool and prophylaxis has been suggested to prevent morbidity and mortality caused due to hospitalized VTE. At our tertiary care teaching hospital, underutilization of VTE thromboprophylaxis was a concern. Aim: This prospective interventional study evaluated the effect of academic detailing on improvement in VTE prophylaxis after risk assessment for critically ill and surgical inpatients at an Indian tertiary care teaching hospital. Methods: A focused group academic detailing for medical practitioners was performed. After the assessment of VTE risk with the help of Caprini VTE risk assessment model, inpatients were monitored for thromboprophylaxis according to risk score. Utilization improvement was assessed by comparing with our published results of the historical preeducation control group. The main outcome measures were VTE risk assessment in hospitalized patients, proportion of prophylaxis in risk categories post education, comparison with findings of the preeducation historical comparison group to assess the improvement of thromboprophylaxis in intensive care unit (ICU), and surgical ward. Results: Thromboprophylaxis was adopted in 288 (56.4%) postacademic detailing as compared to 46 (35.2%) preacademic detailing in the historical control group. The overall prophylaxis for VTE improved significantly with an absolute difference of 21%. The positive impact of academic detailing was significantly observed in ICU compared to surgical ward for VTE prophylaxis. Fear of bleeding and unproven VTE in follow-up Doppler prospective studies in postsurgical patients were the reasons for underutilization. Conclusions: An improvement for VTE prophylaxis was observed in ICU compared to surgical ward. The overall prophylaxis for at-risk VTE inpatients also improved, particularly in higher and highest-risk inpatients.


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