Using knowledge translation for quality improvement: an interprofessional education intervention to improve thromboprophylaxis among medical inpatients

Abstract

Melissa K Myers,1 Claire L Jansson-Knodell,1 Darrell R Schroeder,2 John G O’Meara,3 Sara L Bonnes,4 John T Ratelle5 1Department of Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Health Sceinces Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA; 3Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA; 4Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; 5Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA Background: Low-molecular-weight heparin (LMWH) is an effective means of preventing venous thromboembolism (VTE) among medical inpatients. Compared with unfractionated heparin, LMWH is equivalent or superior in efficacy and risk of bleeding. Despite its advantages, LMWH is underused in VTE prophylaxis for general-medicine patients hospitalized at our institution. Thus, a quality improvement (QI) initiative was undertaken to increase LMWH use for VTE prophylaxis among medical patients hospitalized on resident teaching services. Methods: A QI team was formed, consisting of resident and attending physicians with pharmacy leaders. A systems analysis was performed, which showed gaps in resident knowledge as the greatest barrier to LMWH use. A knowledge translation framework was used to improve prescribing practices. Several Plan–Do–Study–Act cycles were executed, including resident-of-resident and pharmacist-of-resident education with performance audit and feedback. Results: Pharmacist-of-resident education elicited the largest improvement and was sustained through a recurring pharmacist-led, interprofessional educational session as part of the monthly hospital orientation for incoming residents. Data analysis showed a statistically significant increase in LMWH use among treatment-eligible hospitalized medical patients, from 12.1% to 69.2%, following intervention (P<0.001). Extrapolated over 1 year, this improvement conserved 9,490 injections and nearly 791 hours of nurse time. Conclusions: This QI project indicates that an interprofessional education intervention can lead to sustainable improvement in resident prescribing practices. This project also highlights the value of knowledge translation for the design of tailored interventions in QI initiatives. Keywords: implementation science, interprofessional education, interprofessional teamwork, medical education, quality improvement

Keywords

• Implementation Science
• Interprofessional Education
• Interprofessional Teamwork
• Medical Education
• Quality Improvement