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J Crit Care. 2019 Apr;50:111-117. doi: 10.1016/j.jcrc.2018.11.023. Epub 2018 Nov 29.

Improving the adoption of optimal venous thromboembolism prophylaxis in critically ill patients: A process evaluation of a complex quality improvement initiative.

Author information

1
Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada.
2
W21C Research & Innovation Centre, Cumming School of Medicine, University of Calgary, GD01-TRW Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada.
3
Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada.
4
Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada.
5
Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, McMaster University Medical Centre, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada.
6
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Shuter 2-026, Toronto, ON M5B 1W8, Canada.
7
Department of Critical Care Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 St NW, Edmonton, Alberta T6G 2B7, Canada; School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave Edmonton, Alberta T6G 1C9, Canada.
8
Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada. Electronic address: tstelfox@ucalgary.ca.

Abstract

PURPOSE:

This study evaluated a complex initiative to increase evidence-based use of low molecular weight heparin for venous thromboembolism prophylaxis among adult medical-surgical ICU patients.

MATERIALS AND METHODS:

This study included: quantitative survey and interviews. Participants were healthcare providers within four ICUs. Surveys collected knowledge of evidence underpinning best practice, exposure to the implementation strategies and their perceived utility, and recommendations. The interview expanded on survey topics. Descriptive statistics summarized the data and chi-squared tests were used to compare groups. Qualitative data were analyzed using a blended deductive and inductive coding approach.

RESULTS:

Providers had good knowledge of the evidence (range = 58% to 94%). Pharmacist-to-physician reminders (80%), other reminders (50%), and local guidelines (50%) were the most commonly observed strategies. Local champions (76%), on-site education (74%), and computerized decision support system (69%) were perceived to be most helpful. Interviews elicited five themes: provider roles, perceptions of the implementation strategies, facilitators and barriers to uptake of best practice, and recommendations. Assessment of the implementation strategies varied by professional group.

CONCLUSIONS:

The findings of this process evaluation identified implementation strategies that can improve the use of evidence-informed practices, help interpret outcomes in the context of interventions and guide future quality improvement initiatives.

KEYWORDS:

Behavior change; Evidence-based medicine; Health services research; Knowledge measurement; Program evaluation; Quality of care

PMID:
30529419
DOI:
10.1016/j.jcrc.2018.11.023

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