JL408. Decreasing Venous Thromboembolism in Patients With Hematologic Malignancy Through Implementation of Clinical Practice Guidelines – A Quality Improvement Project
Karley M. Trautman, DNP, ANP-BC, and Chelsey Boggs, MS, AGNP-BC; Blood Cancer and Bone Marrow Transplant Program, University of Colorado Anschutz Medical Campus, Aurora, CO
Background: Venous thromboembolism (VTE) is a highly prevalent complication in patients with cancer with reported incidence rates ranging between 8-19% (Khorana, Dalal, Lin, & Connolly, 2013). Patients with VTE have at least a 2-fold increase in mortality compared to those without VTE, even after adjusting for staging (Khorana & Connolly, 2009). Because of this, there is a justifiable need to decrease the incidence of VTE by standardizing practice to align with the current evidence-based practice (EBP) guidelines while simultaneously not increasing bleeding risk in patients with thrombocytopenia. Objective: The aim was to decrease the rate of acute VTE and recurrent VTE in adults with hematologic malignancies by standardizing the risk assessment, use of prophylactic anticoagulation, and treatment duration of therapeutic anticoagulation without increasing bleeding risk in the inpatient and outpatient clinical settings at the University of Colorado Blood Cancers and Bone Marrow Transplant Program. Intervention/Methods: The National Comprehensive Cancer Network (NCCN) VTE guidelines were used to develop a clinical practice guideline addressing standard VTE risk assessment, appropriate use of prophylactic anticoagulation, and standardized duration of therapeutic anticoagulation. Data was collected for 12 months prior to the implementation of the guideline and for 24 month post-implementation. Results: Overall VTE rates decreased from 13.99% to 6.18%, recurrence rate decreased from 42.5% to 20.93%, and bleeding risk improved from 18.52% to 7.06%. Percentage of inpatients receiving prophylactic anticoagulation increased from 25.2% to 42.58% and eligible outpatient myeloma patients receiving prophylaxis increased from 82.76% to 96.97%. Conclusions: Standardization and development of clinical practice guidelines improved VTE incidence and recurrence rates and improved overall adherence to EBP guidelines. Routine prophylactic anticoagulation did not increase bleeding risk in this patient population. Implications for Practice: EBP guidelines aid providers in making sound clinical decisions regarding the management of VTE in patients with hematologic malignancies. Quality improvement projects have a vital role in effective translation of EBP in practice. Data updated at time of publication of this JADPRO issue.
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