Minimizing errors of omission: behavioural reenforcement of heparin to avert venous emboli: the BEHAVE study

Critical Care Medicine
Joseph P McMullinMark Crowther

Abstract

To improve patient safety by increasing heparin thromboprophylaxis for medical-surgical intensive care unit patients using a multiple-method approach to evidence-based guideline development and implementation. Prospective longitudinal observational study. Medical-surgical intensive care unit. Multidisciplinary clinicians caring for critically ill patients in a 15-bed medical-surgical closed intensive care unit. Phase 1 was a 3-month baseline period during which we documented anticoagulation and mechanical thromboprophylaxis. Phase 2 was a 1-yr period in which we implemented a thromboprophylaxis guideline using a) interactive multidisciplinary educational in-services; b) verbal reminders to the intensive care unit team; c) computerized daily nurse recording of thromboprophylaxis; d) weekly graphic feedback to individual intensivists on guideline adherence; and e) publicly displayed graphic feedback on group performance. Phase 3 was a 3-month follow-up period 10 months later, during which we documented thromboprophylaxis. Computerized daily nurse recording of thromboprophylaxis continued in this period. Intensive care unit and hospital mortality rates were similar across phases, although patients in phase 2 had higher Acute Physi...Continue Reading

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