using a standardized vta prophylaxis auditing algorithm improves data quality and accuracy
TRANSCRIPT
USING A STANDARDIZED VTE PROPHYLAXIS AUDITING ALGORITHM IMPROVES DATA QUALITY AND ACCURACY
VANDAD YOUSEFI MD, CCFP SHARI MCKEOWN MA, RRT, FCSRT
QUALITY FORUM FEBRUARY 2016
• Clinical Care Management priority initiative 2010-present
• Supported by a provincial Clinical Expert Group (CEG) and BCPSQC clinical/quality leadership
• Aim: To support local improvement teams across the province to provide appropriate thromboprophylaxis for 100% of hospitalized adult patients
2010-2013
CEG recommendations:
• ‘Gold standard’ evidence-based guidelines
• Preprinted order sets (PPO) and patient risk stratification
• Guidelines for chart audit process
Sept 2013
Variation in chart
selection, auditing
and reporting
Provincial survey
Oct 2013
Survey results:
• Variation throughout the auditing process (chart selection, auditing process, definition of appropriateness, data capture capability)
• In some HA’s, non-clinical staff carried out surveys, where as in others auditors had clinical experience
• In some cases, only the presence of a PPO was captured
• Variation in the auditing process meant:
• Not measuring the same thing in the same way
• Difficult to compare data
• Can’t really aggregate data for a provincial view
• CEG decided to outline a framework to guide the auditing process itself in order to
• Reduce variation in auditing
• Eliminate the burden of determining appropriateness
• Revised operational definition
VTE Audit Algorithm
Patient age < 18 years? or
Documented ‘comfort measures only’? or
Obstetrical patient? or
Designated ‘Alternate Level of Care’? or
Patient on therapeutic doses of anticoagulant at
time of admission.
YES NOExclude from audit
Is patient receiving any of the following
medications?
(list pharmacologic prophylaxis meds here)
Is patient at low risk for VTE?
(define here)
YES NO
Is pharmacologic prophylaxis contraindicated?
(list criteria here)
Is patient receiving mechanical prophylaxis?
(define here)
Is mechanical prophylaxis contraindicated?
(list criteria here)
YES NO
YES NO
YES NO
YES NO
Include in
numerator and
denominator
Include in
numerator and
denominator
Include in
numerator and
denominator
Include in
numerator and
denominator
Include in
denominator only.
Inform nurse or
physician.
Include in
denominator only.
Inform nurse or
physician.
• Feb 2014: algorithm finalized and disseminated
• Nov 2014: auditor training
• Further meetings and circulation in early 2015
UCL
LCL
40%
50%
60%
70%
80%
90%
100%
12
/13
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
13
/14
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
14
/15
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
15
/16
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
VTE Prophylaxis in ICU: Province of B.C. Improvement Goal: 100%
5 health authorities reporting
4 health authorities reporting
40%
50%
60%
70%
80%
90%
100%
12
/13
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
13
/14
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
14
/15
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
15
/16
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
VTE Prophylaxis in Medicine: Province of B.C. Improvement Goal: 100%
5 health authorities reporting
2 health authorities reporting
4 health authorities reporting
5 health authorities reporting One health authority changes audit process
40%
50%
60%
70%
80%
90%
100%
12
/13
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
13
/14
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
14
/15
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
15
/16
P1
P2
P3
P4
P5
P6
P7
P8
P9
P1
0P
11
P1
2P
13
VTE Prophylaxis in Surgery: Province of B.C. Improvement Goal: 100%
5 health authorities reporting
4 health authorities reporting
One health authority changes auditing process
2 health authorities reporting
5 health authorities reporting
Benefits:
• Data is comparable
• Standardizes to minimal requirements, sites can add additional components
• Prompts for ‘measure-vention’
• Allows for non-clinical auditors
Limitations:
• Assumes physicians prescribing prophylaxis are doing it appropriately
• Assumes appropriate risk stratification
Questions?