Evaluation of a Thromboprophylaxis Quality Improvement Project in a Palliative Care Unit
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CONTEXT: The benefits of anticoagulation treatment for primary prophylaxis in patients with advanced progressive diseases are unclear. Moreover, there are no empirically based guidelines on thromboprophylaxis for palliative care patients. OBJECTIVES: To prospectively evaluate a quality improvement protocol on the use of thromboprophylaxis on a 36-bed palliative care unit (PCU). METHODS: A protocol was developed to guide and standardize practice related to venous thromboembolic events (VTE) and anticoagulation medication use on the PCU in patients with a life expectancy of less than six months. Through a prospective audit, data were collected for consecutively admitted patients over a period of four months. RESULTS: Of the 127 patients admitted to the PCU, 41 (32.3%) were on thromboprophylaxis on admission. All but one of these patients had come from an acute care hospital. Thromboprophylaxis was discontinued in 36 (87.8%) of these patients; one patient went on to develop a VTE. Of the 71 patients admitted without thromboprophylaxis, none of the patients were started on thromboprophylaxis and six went on to develop a VTE. CONCLUSION: In this quality improvement study of patients admitted to a PCU largely for end-of-life care, thromboprophylaxis was discontinued in most patients without a significant increase in the incidence of symptomatic VTE. The validity of recommendations extrapolated from the general hospitalized cancer population supporting routine thromboprophylaxis and applied to these patients can be challenged. A policy that requires thromboprophylaxis in all hospitalized cancer patients may run the risk of indiscriminately including patients who are in the terminal phase of their lives.
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