Venous thromboembolism prophylaxis protocols at Brazilian hospitals - PROTEV Brazil

Abstract Background In common with other international guidelines, the Agency for Healthcare Research and Quality recommends implementation of venous thromboembolism (VTE) prophylaxis programs in hospitals as a measure for patient safety. The VTE Safety Zone Program (VTESZ) proposes a model for incorporation of systematic VTE risk-assessment into hospital routines, with continuing institutional and multidisciplinary participation. Objectives To evaluate implementation of VTE prophylaxis initiatives in Brazilian hospitals that have adhered to the VTESZ Program. Methods Questionnaires were e-mailed to VTESZ Program representatives at hospitals visited up to July 2016. Results Of the 132 invitations sent, 68 answers were obtained and 50 (73.5%) were complete. 61.5% of participating hospitals had between 100 and 250 beds, and 65.4% had more than 20 intensive care beds; 61.5% reported having hospital accreditation, 86.3% had VTE prophylaxis committees, and 58% had electronic medical records. VTE risk assessments using the Brazilian guidelines or the Padua or Caprini scores were noted on the electronic medical record in 56.9% and were a mandatory step in 45.1% of the cases. VTE risk reassessment was requested prior to discharge in only 25% of hospitals and several issues were cited that negatively affect the VTESZ implementation process. Conclusions This study provides an overview of implementation of VTESZ in Brazilian hospitals. Systematic risk assessment is not yet conducted for most patients. Recognition of various issues affecting the process may lead to new strategies for achieving adequate prophylaxis and safety of hospitalized patients.研究背景：与其他国际指南一致，美国医疗保健研究与质量局（Agency for Healthcare Research and Quality）推荐在医院内实施静脉血栓栓塞症（venous thromboembolism, VTE）预防方案，作为保障患者安全的核心措施。VTE安全地带项目（VTESZ Program）构建了将系统性VTE风险评估嵌入医院日常诊疗流程的框架，并倡导医疗机构与多学科团队持续参与项目落地。 研究目的：本研究旨在评估参与VTESZ项目的巴西医院中VTE预防措施的实施现状。 研究方法：向截至2016年7月已加入VTESZ项目的医院的项目代表发送电子邮件问卷。 研究结果：本次共发出132份调研邀请，回收有效回复68份，其中50份（73.5%）为完整答卷。参与调研的医院中，61.5%的开放床位数量介于100至250张之间，65.4%拥有20张以上重症监护床位；61.5%的医院具备医院认证资质，86.3%设有VTE预防委员会，58%配备电子病历（electronic medical records）系统。在56.9%的电子病历中记录了采用巴西临床指南、帕杜评分（Padua score）或卡普利尼评分（Caprini score）开展的VTE风险评估，其中45.1%的病例将该评估设为强制诊疗流程。仅25%的医院要求在患者出院前进行VTE风险复评，同时调研明确了若干阻碍VTESZ项目落地实施的负面因素。 研究结论：本研究概述了巴西医院实施VTESZ项目的整体现状。当前多数住院患者尚未接受系统性VTE风险评估。厘清影响项目推进的各类问题，可为制定完善住院患者VTE预防方案、保障患者安全的优化策略提供实践方向。