Thromboprophylaxis Management in Surgical Patients: The Efficacy of a Protocol in the Electronic Prescription Program.

BACKGROUND AND OBJECTIVE: Venous thromboembolism (VTE) continues to be a problem in surgical patients, but thromboprophylactic measures are not always implemented. This study aimed to evaluate thromboprophylaxis practice in surgical patients at our institution by assessing appropriateness during admission and discharge; 60-day clinical outcomes are analyzed, and finally further interventions are discussed for continued improvement. METHODS: A cross-sectional, observational study was conducted in patients undergoing orthopedic and abdominal surgical procedures. Initially, the institution protocol was updated and embedded in the Computerized Physician Order Entry system. We then assessed prospective adequacy of thromboprophylaxis as per established in the protocol. The primary endpoint was thromboprophylaxis initiation and, secondarily, the quality of related prescriptions during hospitalization and at discharge. RESULTS: A total of 114 patients were included in the study. According to VTE risk, thromboprophylaxis was initiated in 85.1% of the patients as needed during hospitalization and 94.8% at discharge. The following inadequacies versus the protocol were found: no duration information in the discharge summary (32.5%), incorrect postsurgical administration time of pharmacological prophylaxis (15.8%), omission of mechanical prophylaxis (13.7%), misdosing (9.6%), and omission of pharmacological prophylaxis (2.6%). No VTE events occurred 60 days postdischarge. CONCLUSION: The electronic protocol was an effective tool, as evidenced by the fact that thromboprophylaxis was initiated in the majority of surgical patients in our institution during hospitalization and at discharge. Still, some aspects leave room for improvement (duration, dosing, and timing), and further measures such as implementation of Electronic Medication Administration Records and new functionalities in the Clinical Decision Support systems are proposed.

Readmission Due to Exacerbation of COPD: Associated Factors.

OBJECTIVES: To compare characteristics of patients readmitted after discharge by chronic obstructive pulmonary disease (COPD) exacerbation with those who were not readmitted and to identify factors associated with readmission risk. PATIENTS AND METHODS: We randomly selected a group of 40 COPD patients with high frequency of readmissions (HFR), who had ≥ 2 admissions by COPD exacerbation within 30 days after the last admission in 2015, and another group of 40 COPD patients with low frequency of readmissions (LFR), with 0-1 admissions in that period. RESULTS: Patients of the HFR group, compared to those in LFR group, were more frequently males (p = 0.009), older (p = 0.022), had a higher degree of dyspnea (p = 0.044), worse lung function (p = 0.049), belonged more frequently to exacerbator emphysema phenotype (p < 0.001), and had a higher frequency of diabetes (p = 0.049). The variables independently associated with increased risk of HFR were sex (OR 0.06, 95% CI 0.01-0.63, in women in relation to males), exacerbator emphysema phenotype (OR 28.61, 95% CI 3.59 compared to non-exacerbator phenotype), complications during hospitalization (OR 0.09, 95% CI 0.01-0.62, compared with those without complications), destabilized heart failure (OR 5.25, 95% CI 1.11-24.75, compared to those who did not), and length of hospital stay (OR 0.79, 95% CI 0.65-0.95, per day). CONCLUSIONS: Chronic obstructive pulmonary disease patients with HFR are more frequently male, older, have worse dyspnea, lower lung function, belong more frequent to exacerbator emphysema phenotype, and more frequently diabetics. The variables that continued to be independent predictors of HFR in the multivariate analysis were sex, phenotype, occurrence of complications during admission, destabilized heart failure, and length of hospital stay.

[Detection of adverse events using trigger tools in 2hospital units in Spain]. / Detección de eventos adversos mediante trigger tools en 2unidades de hospitalización de un hospital terciario en España.

INTRODUCTION: Adverse events (AE) related to health care are frequent due to the nature of this activity, and for this reason, it is necessary to develop methods to detect them and prevent their recurrence. One of these methods uses what are called trigger tools, which are markers that allow AE to be identified retrospectively for subsequent analysis. OBJECTIVES: To evaluate the usefulness of a trigger tools system to detect AE related to patient safety in Internal Medicine and General Surgery units of a tertiary referral hospital. As secondary objectives, measurements were made of the rate of AE, its prevalence in admissions, as well as a description of the different types of AE, and to evaluate the time spent using this tool. MATERIAL AND METHODS: A retrospective descriptive study of patients admitted to the units of Internal Medicine and General Surgery and discharged during 2016. Inclusion criteria were hospital stay over 24h and the presence of a complete clinical record of the studied acute episode. Patients admitted to short-stay units were excluded. A verification questionnaire was designed to registry key study variables and associated AE. RESULTS: The study included 118 patients from Internal Medicine and 115 from General Surgery. The presence of at least one trigger was detected in 86 (72.9%) Internal Medicine and 56 (48.7%) General Surgery patients. Of these, 13 (15.1%) were associated with the presence of an AE in Internal Medicine and 34 (60.7%) in General Surgery. The trigger tool system failed to detect 7 AE, 4 of them in Internal Medicine. The median of triggers identified in each patient was 1.5 (IQR p25-p75: 1-2.5) in Internal Medicine and 2 (IQR p25-p75: 1-4) in General Surgery. In total, 262 positive triggers were detected, of which 157 corresponded to Internal Medicine, most of them related to early emergency re-admission after discharge. Most of the identified AEs required re-hospitalisation or extending the length of stay. CONCLUSIONS: Trigger tools systems are useful for the detection and characterisation of AE, which helps to analyse and implement improvement measures.