Evaluation of venous thromboembolism prophylaxis after the introduction of an institutional guideline: Extent of application and implementation of its recommendations

• A risk assessment sheet for venous thromboembolism (VTE) is present in fewer than one-half of the patients' files.
• When present, the Caprini score was correct in only one-half of the files.
• The rate of VTE prophylaxis has increased in the high and highest risk groups since 2006.
• More improvement is needed in implementation of the risk assessment score for VTE.

Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism. Although much is known about risk factors for VTE, there is failure in administration of appropriate prophylaxis to patients who are at risk for VTE. A paper-based reminder system is considered to be among the most effective methods of improving VTE prophylaxis in hospitalized patients. However, their success relies on choosing an evidence-based institutional guideline and implementation of its recommendations. This study was carried out to detect the extent of application of the institutional guideline (Caprini score risk assessment sheet). The study was carried out in the Jordan University Hospital; 354 patients were enrolled in the study and distributed among the following wards: nonorthopedic surgical (n = 119), medical (n = 220), and surgical orthopedic wards (n = 15). The risk assessment sheet was present in only 47.2% of the patient's' files, and the scores in the files were estimated correctly in only 52.1% of cases. Prophylaxis received by patients matched the recommendation of the Caprini score in 67.1% of the patients. The degree of concordance of the VTE prophylaxis with the Caprini score was 59.9%. This study showed that the institutional guideline was poorly implemented in the hospital.