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International Journal for Quality in Health Care Advance Access published online on August 27, 2007
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzm034
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© The Author 2007. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

Intervention targeted at nurses to improve venous thromboprophylaxis

Jose Labarere1,2, Jean-Luc Bosson2,3, Marie-Antoinette Sevestre2,4, Elodie Sellier1, Cecile Richaud5 and Annie Legagneux6

1 Unité d'Evaluation Médicale, Centre Hospitalier Universitaire, Grenoble
2 ThEMAS, TIMC, UMR CNRS 5525 UJF, Grenoble
3 Centre d'Investigation Clinique, INSERM, Centre Hospitalier Universitaire, Grenoble
4 Unité de Médecine Vasculaire, Centre Hospitalier Universitaire, Amiens
5 Département de Médecine Gériatrique et Communautaire, Centre Hospitalier Universitaire, Grenoble
6 Unité de Médecine Vasculaire, Hôpital Mémorial France Etats-Unis, Saint-Lô, France

Objective. To assess the effectiveness of an intervention targeting both physicians and nurses vs. physicians only in improving venous thromboprophylaxis for older patients.

Design. Cluster randomized trial.

Setting. Fifty hospital-based post-acute care departments in France.

Participants. Patients aged 65 years or older.

Intervention. A multifaceted intervention to implement a clinical practice guideline addressing venous thromboprophylaxis.

Main outcome measures. The effectiveness outcomes were elastic stocking use, ambulation or mobilization under the supervision of a physical therapist and anticoagulant-based prophylaxis. Patient outcomes included deep vein thrombosis and anticoagulant-related adverse events.

Results. One department allocated to the intervention targeted at physicians only and seven departments allocated to the intervention targeted at both physicians and nurses dropped out of the study. Compared with the intervention targeted at physicians only (n = 497 patients), the intervention targeted at both physicians and nurses (n = 315 patients) was associated with a higher rate of mobilization (62 vs. 37%, P < 0.001) and comparable levels of elastic stocking (32 vs. 39%, P = 0.74) and anticoagulant (55 vs. 48%, P = 0.36) use. The rates of deep vein thrombosis (15 vs. 13%, P = 0.50), bleeding (1 vs. 1%, P = 0.99) and thrombocytopaenia (0 vs. 0.2%, P = 0.99) did not differ between the two groups.

Conclusions. A multifaceted intervention targeting nurses in addition to physicians can increase the frequency of mobilization of older patients to prevent venous thromboembolism but does not alter the use of elastic stockings and anticoagulant. A differential drop-out of departments might have contributed to creating imbalances in baseline characteristics and outcomes in this study.

Keywords: aged, aged 80 and over, nurses, practice guidelines, randomized controlled trial, venous thrombosis

Address reprint requests to: Jose Labarere, Unité d'Evaluation Médicale, Pavillon Taillefer, CHU BP 217, 38043 Grenoble Cedex 9, France. Tel: (+33) 4 76 76 87 67; Fax: (+33) 4 76 76 88 31; E-mail: jLabarere{at}chu-grenoble.fr

Accepted for publication July 3, 2007.


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