Quality of venous thromboembolism prophylaxys in a university hospital in Brazil

Abstract

Objective: Though recommended, prophylaxis for venous thromboembolism is not always correctly prescribed. In light of this fact, our objective is to evaluate the quality of medical prescriptions with regards to venous thromboembolism prophylaxis in a brazilian teaching hospital. Methods: During a 30-day period, medical prescriptions to patients treated at the internal medicine ward, surgery ward and at the intensive care unit were assessed. Patients on anticoagulants for a non-prophylactic reason were excluded. This cross-sectional analysis evaluated the appropriateness of venous thromboembolism prophylaxis based on the 9th Guideline of the American College of Chest Physicians. Results: 358 prescriptions have been firstly assessed, of which 65 were excluded. Out of 293 selected prescriptions, 106 (36.2%) were considered inaccurate. The main cause of inadequacy was underprescription, which was observed in 72 cases (67.9%). Surgery wards accounted for the majority of inaccurate precriptions (48.72%) compared to internal medicine (35.11%) and critical care ones (26.2%) (p=0.0013). Conclusion: Alarming rates of inadequate prescriptions regarding venous thromboembolism prophylaxis were found. Underprescription was the main cause of inadequacy. Surgery wards were responsible for most of the imprecision. Further interventions are required in order to improve this important and safe medical practice for hospitalized patients.