Student Dissertation

Agency : Venous thrombo-embolism; Venous Thromboembolism prophylaxis; compliance of patient assessment; VTE prevention

Objective : To improve the health care professional’s compliance with evidence?based guidelines for VTE prevention in hospitalized patients.” Ho: There is no significant effect on the VTE noncompliance status after the intervention. H1: There is a significant effect on the VTE noncompliance status after the intervention • To investigate the compliance of patient assessment for venous thromboembolism within 48 hours of admission in the hospital. • To measure the compliance of initiating the prophylactic measures according to the VTE status of the patients. • To test whether a certain targeted intervention will reduce noncompliance or not.

Background : Venous thromboembolism (VTE) is a potentially preventable complication in every hospitalized patient. The spectrum varies from asymptomatic DVT (deep vein thrombosis) to sudden unexplained death due to Pulmonary Embolism (PE). Long-term sequelae include chronically swollen leg and venous ulcers which are difficult to manage and entail considerable costs to the patient as well as the society. Timely risk assessment and appropriate use of prophylaxis to prevent VTE in those at risk is a critical safety practice in Max Healthcare. Venous Thromboembolism is no longer a rarity in India.” Until the 1990s, venous thromboembolism (VTE) was viewed primarily as a complication of hospitalization for major surgery (or associated with the late stage of terminal illness). However, recent trials in patients hospitalized with a wide variety of acute medical illness have demonstrated a risk of VTE in medical patients compared with that seen after major general surgery. Mortality and morbidity from VTE is a significant problem in India. It is one of the commonest causes of unplanned readmission and preventable death. General surgical operations are the most common causes of post-operative DVT. Pulmonary embolism continues to be suspected more than it is diagnosed may contribute to up to 12% of deaths in ICU and is the No.1 preventable cause of hospital death. Silent DVT is present in 5-10% of ICU patients despite thrombo-prophylaxis. ICU doctors often have a skewed perception of the risk of bleeding in ICU patients, predisposing them to avoid anticoagulation. So, there is a need to create awareness amongst the concerned authorities to put light on the issue and to work in the direction of reducing the incidence by providing the required prophylaxis.

Methodology : Sample size: The sample size for the study is 726 inpatients. Sampling: Purposive sampling Study Design: Observational study and Quasi-experimental (Pre and Post Intervention Independent sample study) Sampling criteria/Selection: Patients who had completed 48 hours from the time of admission in the hospital from Feb 2018 – April 2018. Sample Population: Inpatient of 5 departments admitted in Max Superspeciality Hospital, Dehradun (Cardiology, Neurology, Orthopedics, General Surgery, and Obs & Gynae) Data collection: The data was collected through CPRS software used in the hospital. Data analysis: Analysis was done under MS Excel and results presented in the form of different charts. Study duration: Three months (Feb 2018- April 2018)

Findings : From February to March it was observed that because of regular follow-ups in Cardio, Neurology, & Obs & Gynae registered a statistically significant reduction in noncompliance. Orthopedics & General surgery registered a non-significant reduction in noncompliance. This was because of the following reasons. Absence of two doctors at the same time for a long duration. Doctors coordinator left the job. Thus, regular follow up was increased in orthopedics and general surgery in next month and in the other three departments the concentration of follow-up was diluted. From March to April increase in compliance was seen in Orthopedics and General Surgery although it was not statistically significant. It was a worrisome finding that in the departments where improvement was seen after the first intervention, there was again a reversal of pendencies which was statistically significant thus indicating that regularly follow up has to be continuously done and any dilutions in the same would be detrimental to compliances.

Recommendations :

Research Question: • How much is the compliance in the provision of Venous Thromboembolism prophylaxis in inpatients of Max Super specialty, Dehradun and what are the challenges faced?