TY - JOUR
T1 - Achieving durable compliance with venous thromboembolism prophylaxis in bariatric surgery
T2 - 3-year data from a major academic medical center
AU - Mou, Danny
AU - Falconer, Elissa
AU - Majumdar, Melissa
AU - Delgado, Tori
AU - Fay, Katherine
AU - Hall, Carrie E.
AU - Smach, Carla
AU - Ashraf, Shanza
AU - Levett, Sydnee
AU - Lin, Edward
AU - Davis, Scott
AU - Patel, Ankit
AU - Stetler, Jamil
AU - Serrot, Federico
AU - Srinivasan, Jahnavi
AU - Oyefule, Omobolanle
AU - Diller, Maggie
AU - Hechenbleikner, Elizabeth
N1 - Publisher Copyright:
© 2024 American Society for Metabolic and Bariatric Surgery
PY - 2024/1
Y1 - 2024/1
N2 - Background: Metabolic and bariatric surgery (MBS) venous thromboembolism (VTE) prescribing practices vary widely. Our institutional VTE prophylaxis protocol has historically been unstandardized. Objectives: To create a standardized MBS VTE prophylaxis protocol, track protocol compliance, and identify barriers to protocol compliance and address them with Plan-Do-Study-Act (PDSA) cycles. Setting: Single Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited academic hospital. Methods: We conducted a retrospective study for all patients undergoing MBS (January 2019 to September 2022). A multidisciplinary group of bariatric clinicians reviewed literature and developed the following standardized VTE prophylaxis protocol: 5000 units preoperative subcutaneous (SC) heparin within 60 minutes of anesthesia induction and postoperative 40 mg SC low molecular weight heparin (LMWH) within 24 hours of surgery. This protocol was distributed to relevant clinical stakeholders. We assessed monthly compliance rates through chart review. Goal compliance was ≥90%. We identified sources of noncompliance and addressed them with PDSA methodology. Results: A total of 796 patients were included. Preoperative heparin administration increased from a mean of 47% (107/228) preintervention to 96% (545/568) postintervention (P < .0001), and postoperative LMWH administration increased from 71% (47/66) to 96% (573/597, P = .0002). These compliance rates were sustained for 3 years. Barriers to protocol noncompliance included order set timing errors (n = 45), surgeon error (n = 44), surgeon discretion (n = 40), and nursing error (n = 20). No change in bleeding or VTE rates was observed. Conclusions: Developing a standardized VTE prophylaxis protocol, monitoring process measures, and engaging relevant stakeholders in PDSA cycles resulted in drastic and durable improvement in VTE prophylaxis compliance rates.
AB - Background: Metabolic and bariatric surgery (MBS) venous thromboembolism (VTE) prescribing practices vary widely. Our institutional VTE prophylaxis protocol has historically been unstandardized. Objectives: To create a standardized MBS VTE prophylaxis protocol, track protocol compliance, and identify barriers to protocol compliance and address them with Plan-Do-Study-Act (PDSA) cycles. Setting: Single Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited academic hospital. Methods: We conducted a retrospective study for all patients undergoing MBS (January 2019 to September 2022). A multidisciplinary group of bariatric clinicians reviewed literature and developed the following standardized VTE prophylaxis protocol: 5000 units preoperative subcutaneous (SC) heparin within 60 minutes of anesthesia induction and postoperative 40 mg SC low molecular weight heparin (LMWH) within 24 hours of surgery. This protocol was distributed to relevant clinical stakeholders. We assessed monthly compliance rates through chart review. Goal compliance was ≥90%. We identified sources of noncompliance and addressed them with PDSA methodology. Results: A total of 796 patients were included. Preoperative heparin administration increased from a mean of 47% (107/228) preintervention to 96% (545/568) postintervention (P < .0001), and postoperative LMWH administration increased from 71% (47/66) to 96% (573/597, P = .0002). These compliance rates were sustained for 3 years. Barriers to protocol noncompliance included order set timing errors (n = 45), surgeon error (n = 44), surgeon discretion (n = 40), and nursing error (n = 20). No change in bleeding or VTE rates was observed. Conclusions: Developing a standardized VTE prophylaxis protocol, monitoring process measures, and engaging relevant stakeholders in PDSA cycles resulted in drastic and durable improvement in VTE prophylaxis compliance rates.
KW - Bariatric surgery
KW - Compliance
KW - Pulmonary embolus
KW - Quality improvement
KW - Venous thromboembolism prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=85170215280&partnerID=8YFLogxK
U2 - 10.1016/j.soard.2023.08.008
DO - 10.1016/j.soard.2023.08.008
M3 - Article
C2 - 37684191
AN - SCOPUS:85170215280
SN - 1550-7289
VL - 20
SP - 72
EP - 79
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 1
ER -