The factors included in the fishbone diagram were brainstormed by the members of the team and were based on individual experience. The factors were not quantified. Of these reasons, the team specifically focused on ‘provider factors’ because among physicians there may be low awareness of venous thromboembolism evidence-based guidelines.[2] Several published studies have proposed multifaceted strategies

to change physician prescribing behaviour including education and incorporating the task into the physician’s workflow.[3, 4] Based on these strategies, the team brainstormed various interventions that could influence these ‘provider factors’ (Table 1). Create poster reminder to perform a DVT risk assessment. Conduct an in-service CX-5461 mouse regarding the importance of DVT prophylaxis PD0325901 chemical structure Nurse driven risk stratification and prophylaxis order Pharmacist

driven risk stratification and prophylaxis order Force function for DVT score and orders in the electronic medical record Computerized physician order entry Computerized DVT prophylaxis reminders The GIM team felt that the best intervention would be to embed the DVT risk-assessment tool and DVT orders into a standardized physician admission order-set and to educate users regarding the availability of the order-set. Users were not informed that the order-set was created to improve DVT prophylaxis rates. The team then created an aim statement that stated: ‘This Dichloromethane dehalogenase project will increase the percentage of newly admitted GIM patients receiving optimal

DVT prophylaxis by developing a standardized medicine admission order-set with an embedded risk-assessment tool and DVT prophylaxis orders. The preliminary review indicated that there were 65 admitted GIM patients in a 1-month period. Of the 65 patient charts, VTE forms were completed by a physician in only two charts (3%). Of the 65 patients admitted, only 49 (75%) received appropriate prophylaxis. Two-month post-intervention data indicated that of 72 GIM patients audited in a 1-month period, the standardized admission orders were used 86% of the time and that 91% of the patients received optimal DVT prophylaxis. The number of patients receiving correct DVT prophylaxis increased from 75% to 91%. Chart review 1 year after the implementation of the order-set revealed that the increase in DVT prophylaxis was sustained at 95% even after the project was complete. Utilization of the embedded risk-assessment tool for DVT prophylaxis increased from 3% to 86% but declined to 64% at the 1-year review (Figure 2). However, the use of the DVT orders within the order-set remained high at 90%. Of the 72 patient charts audited at 2 months, patients were more likely to receive prophylaxis (94%) when the standardized order-set was completed versus when the orders were not completed (70%).

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