Using a Standardized VTA Prophylaxis Auditing Algorithm Improves Data Quality and Accuracy

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


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 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%



One health authority changes auditing process



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?

Using a Standardized VTA Prophylaxis Auditing Algorithm Improves Data Quality and Accuracy

Healthcare