Major Finding: Distribution of antithrombotic guidelines increased the rate of VTE risk assessment and prophylaxis from 50% to 82% in long-term care settings.
Data Source: Study of 738 newly admitted residents in 17 long-term care facilities.
Disclosures: The investigators reported having no disclosures.
LONG BEACH, CALIF. — An educational intervention led to increased preventive management of venous thromboembolism in residents of long-term care facilities.
Preventive management—assessment of VTE risk and prophylaxis in appropriate patients—was used in 50% of 376 newly admitted residents prior to the intervention and in 82% of 362 new admissions afterward.
Before the intervention, clinical guidelines on VTE prevention were ignored or misunderstood during the care of 32% of new residents. After the intervention, this occurred during the care of 17% of new residents, Dr. T. S. Dharmarajan and his associates reported in two poster presentations at the annual meeting of the American Medical Directors Association. Inappropriate use of VTE prophylaxis (for example, in a patient already anticoagulated for atrial fibrillation) fell from 23% of assessed residents to 13%.
No guidelines for VTE prevention are written specifically for long-term care settings, and the scope of acute VTE and pulmonary embolism in long-term care residents is unknown, said Dr. Dharmarajan of Montefiore Medical Center, New York.
Researchers surveyed clinicians at 17 long-term care facilities in nine states about their VTE prevention practices. Participating clinicians received copies of guidelines issued in 2008 by the American College of Chest Physicians for VTE prevention in hospitalized patients and an antithrombotic “toolkit” developed by the American Medical Directors Association.
After this educational intervention, the likelihood that a new resident would be assessed or given prophylaxis for VTE increased 14-fold in a logistic regression modeling analysis, Dr. Dharmarajan reported. Listing contraindications as a reason for not providing prophylaxis against VTE fell by 67%.
Significant changes in prophylaxis choices after the intervention included less reliance on aspirin alone (18% after vs. 36% before) and more reliance on compression devices alone (4% vs. 0%) or ambulation alone (55% vs. 39%). Common prophylactic measures that did not change significantly included the use of warfarin, heparin, low-molecular-weight heparin, fondaparinux, or stockings.