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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
pharmacology, toxicology and pharmaceutics
The TOronto ThromboProphylaxis Patient Safety Initiative (TOPPS): A cluster randomised trial
Research in Social and Administrative Pharmacy, Volume 13, No. 5, Year 2017
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Description
Background Although venous thromboembolism (VTE) is one of the most common and most preventable complications of hospital stay, review of the literature demonstrates large evidence-care gaps for VTE prevention. Objectives This study aimed to determine if a multi-component quality improvement (QI) strategy, including the support of hospital leadership, use of order sets, audit and feedback, and active pharmacy involvement, could increase the use of appropriate thromboprophylaxis in patients hospitalized for hip fracture surgery (HFS), major general surgery (MGS) and acute medical illness (MED). Methods TOPPS was a cluster randomized trial involving eight hospitals. After a baseline data collection phase, one of the three patient groups at each site was randomized to the targeted QI intervention while the other two groups served as controls. In the next phase, an additional patient group at each site was randomized to the intervention while the third group remained controls. Standardized chart audits were conducted to assess the rates of appropriate thromboprophylaxis use. Results At baseline, the rates of appropriate thromboprophylaxis were 79% in HFS, 43% in MGS and 31% in MED. By the end of phase 3, 89% of HFS, 65% of MGS and 70% of MED patients were receiving appropriate prophylaxis. Improvement was greater in the intervention groups compared to controls (85% vs. 76% in HFS; 67% vs. 54% in MGS; 64% vs. 62% in MED) and this difference reached significance in the MGS group (p = 0.048). Conclusions Use of a multi-component intervention can be effective in improving the appropriate use of thromboprophylaxis. © 2017 Elsevier Inc.
Authors & Co-Authors
Diamantouros, Artemis
Canada, Toronto
Sunnybrook Health Sciences Centre
Canada, Toronto
University of Toronto
Kiss, Alex J.
Canada, Toronto
Institute for Clinical and Evaluative Sciences
Zwarenstein, Merrick F.
Canada, Toronto
Institute for Clinical and Evaluative Sciences
Canada, London
Western University
Geerts, William H.
Canada, Toronto
Sunnybrook Health Sciences Centre
Canada, Toronto
University of Toronto
Statistics
Citations: 2
Authors: 4
Affiliations: 4
Identifiers
Doi:
10.1016/j.sapharm.2017.05.015
ISSN:
15517411
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Grounded Theory