Protocolos de profilaxia de tromboembolismo venoso (TEV) em hospitais brasileiros - PROTEV Brasil
Venous thromboembolism prophylaxis protocols at Brazilian hospitals - PROTEV Brazil
Ana Thereza Cavalcanti Rocha; Thiago Brito Pinheiro; Paulo Roberto Sampaio Peixoto de Souza; Marcos Arêas Marques
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Abstract
In common with other international guidelines, the Agency for Healthcare Research and Quality recommends implementation of venous thromboembolism (VTE) prophylaxis programs in hospitals as a measure for patient safety. The VTE Safety Zone Program (VTESZ) proposes a model for incorporation of systematic VTE risk-assessment into hospital routines, with continuing institutional and multidisciplinary participation. Objectives: To evaluate implementation of VTE prophylaxis initiatives in Brazilian hospitals that have adhered to the VTESZ Program. Methods: Questionnaires were e-mailed to VTESZ Program representatives at hospitals visited up to July 2016. Results: Of the 132 invitations sent, 68 answers were obtained and 50 (73.5%) were complete. 61.5% of participating hospitals had between 100 and 250 beds, and 65.4% had more than 20 intensive care beds; 61.5% reported having hospital accreditation, 86.3% had VTE prophylaxis committees, and 58% had electronic medical records. VTE risk assessments using the Brazilian guidelines or the Padua or Caprini scores were noted on the electronic medical record in 56.9% and were a mandatory step in 45.1% of the cases. VTE risk reassessment was requested prior to discharge in only 25% of hospitals and several issues were cited that negatively affect the VTESZ implementation process. Conclusions: This study provides an overview of implementation of VTESZ in Brazilian hospitals. Systematic risk assessment is not yet conducted for most patients. Recognition of various issues affecting the process may lead to new strategies for achieving adequate prophylaxis and safety of hospitalized patients.
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References
1 Office of the Surgeon General. The surgeon general’s call toaction to prevent deep vein thrombosis and pulmonary embolism [Internet]. Bethesda: National Center for Biotechnology Information; 2008 [citado 2019 set 9].
2 Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133(6, Supl):381-453.
3 Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf. 2013;22(10):809-15.
4 Chindamo MC, Marques MA. Role of ambulation to prevent venous thromboembolism in medical patients: where do we stand? J Vasc Bras. 2019;18:e20180107.
5 Darze ES, Casqueiro JB, Ciuffo LA, Santos JM, Magalhães IR, Latado AL. Pulmonary embolism mortality in brazil from 1989 to 2010: gender and regional disparities. Arq Bras Cardiol. 2016;106(1):4-12.
6 Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess. 2001;2001(43):i-x. PMid:11510252.
7 Rocha ATC, Braga P, Ritt G, Lopes AA. Inadequação de tromboprofilaxia venosa em pacientes clínicos hospitalizados. Rev Assoc Med Bras. 2006;52(6):441-6.
8 Erzinger FL, Carneiro MB. Prevenção de tromboembolismo venoso em hospital com perfil oncológico: como melhorá-la? J Vasc Bras. 2016;15(3):189-96.
9 Lopes BAC, Teixeira IP, Souza TD, Tafarel JR. Sabemos prescrever profilaxia de tromboembolismo venoso nos pacientes internados? J Vasc Bras. 2017;16(3):199-204.
10 Cohen AT, Tapson VF, Bergmann J-F, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387-94.
11 Curtarelli A, Silva LPC, Camargo PAB, et al. Profilaxia de tromboembolismo venoso, podemos fazer melhor? Perfil de risco e profilaxia de tromboembolismo venoso em hospital universitário do interior do estado deSão Paulo. J Vasc Bras. 2019;18:e20180040.
12 Paiva EF, Rocha ATC. Como implementar uma diretriz: da teoria à prática exemplo da profilaxia para tromboembolismo venoso. Acta Med Port. 2009;22(1):21-32. PMid:19341590.
13 Rocha AT, Paiva EF, Bernardo WM. Atualização em tromboembolismo venoso: profilaxia em pacientes clínicos - Parte III. Rev Assoc Med Bras. 2009;55(5):519-20.
14 Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2, Supl):e419S-96S.
15 Instituto Qualisa de Gestão [site na Internet]. 2019 [citado 2019 set 9].
16 Instituto Brasileiro para Segurança do Paciente – IBSP. Segurança do paciente [internet]. 2019 [citado 2019 set 9].
17 Tooher R, Middleton P, Pham C, et al. A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals. Ann Surg. 2005;241(3):397-415.
18 Rocha ATC, Paiva EF, Araújo DM, et al. Impacto de um programa para profilaxia de tromboembolismo venoso em pacientes clínicos em quatro hospitais de Salvador. Rev Assoc Med Bras. 2010;56(2):197-203.
19 Brasil. Cadastro Nacional de Estabelecimentos de Saúde – CNES [site na Internet]. 2019 [citado 2019 set 9].