Educational outreach visits to improve venous thromboembolism prevention in hospitalised medical patients: a prospective before-and-after intervention study

Journal article


Duff, Jed, Omari, Abdulla, Middleton, Sandy, McInnes, Elizabeth and Walker, Kim. (2013) Educational outreach visits to improve venous thromboembolism prevention in hospitalised medical patients: a prospective before-and-after intervention study. BMC Health Services Research. 13(1), pp. 1 - 9.
AuthorsDuff, Jed, Omari, Abdulla, Middleton, Sandy, McInnes, Elizabeth and Walker, Kim
Abstract

Background Despite the availability of evidence-based guidelines on venous thromboembolism (VTE) prevention clinical audit and research reveals that hospitalised medical patients frequently receive suboptimal prophylaxis. The aim of this study was to evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV) on the provision of VTE prophylaxis to hospitalised medical patients in a 270 bed acute care private hospital in metropolitan Australia. Methods The study used an uncontrolled before-and-after design with accompanying process evaluation. The acceptability of the intervention to participants was measured with a post intervention survey; descriptive data on resource use was collected as a measure of utility; and clinical impact (prophylaxis rate) was assessed by pre and post intervention clinical audits. Doctors who admit >40 medical patients each year were targeted to receive the intervention which consisted of a one-to-one educational visit on VTE prevention from a trained peer facilitator. The EOV protocol was designed by a multidisciplinary group of healthcare professionals using social marketing theory. Results Nineteen (73%) of 26 eligible participants received an EOV. The majority (n = 16, 85%) felt the EOV was effective or extremely effective at increasing their knowledge about VTE prophylaxis and 15 (78%) gave a verbal commitment to provide evidence-based prophylaxis. The average length of each visit was 15 minutes (IQ range 15 to 20) and the average time spent arranging and conducting each visit was 92 minutes (IQ range 78 to 129). There was a significant improvement in the proportion of medical patients receiving appropriate pharmacological VTE prophylaxis following the intervention (54% to 70%, 16% improvement, 95% CI 5 to 26, p = 0.004). Conclusions EOV is effective at improving doctors’ provision of pharmacological VTE prophylaxis to hospitalised medical patients. It was also found to be an acceptable implementation strategy by the majority of participants; however, it was resource intensive requiring on average 92 minutes per visit.

KeywordsEducational outreach visit; Implementation science; Venous thromboembolism prevention
Year2013
JournalBMC Health Services Research
Journal citation13 (1), pp. 1 - 9
PublisherBiomed Central Ltd
ISSN1472-6963
Scopus EID2-s2.0-84884996771
Open accessOpen access
Page range1 - 9
Publisher's version
Place of publicationUnited Kingdom
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McInnes, Elizabeth and Phillips, R. (2013) P159: The views of senior hospital managers on innovative strategies to improve hand hygiene adherence: a qualitative study. Antimicrobial Resistance and Infection Control. 2(1). https://doi.org/10.1186/2047-2994-2-S1-P159
Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care: An integrative review
Schadewaldt, Verena, McInnes, Elizabeth, Hiller, Janet and Gardner, Anne. (2013) Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care: An integrative review. BMC Family Practice. 14(132), pp. 1 - 11. https://doi.org/10.1186/1471-2296-14-132
Research involvement, support needs, and factors affecting research participation: A survey of Mental Health Consultation Liaison Nurses
McMaster, Rose, Jammali-Blasi, Asmara, Andersson-Noorgard, Kurt, Cooper, Kerrie and McInnes, Elizabeth. (2013) Research involvement, support needs, and factors affecting research participation: A survey of Mental Health Consultation Liaison Nurses. International Journal of Mental Health Nursing. https://doi.org/10.1111/j.1447-0349.2012.00857.x
Support surfaces for treating pressure injury: A Cochrane systematic review
McInnes, Elizabeth, Jammali-Blasi, Asmara, Cullum, Nicky, Bell-Syer, Sally and Dumville, Jo. (2013) Support surfaces for treating pressure injury: A Cochrane systematic review. International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2012.05.008
Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ
Tong, Allison, Flemming, Kate, McInnes, Elizabeth, Oliver, Sandy and Craig, Jonathon. (2012) Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Medical Research Methodology. 12(181), pp. 1 - 8. https://doi.org/10.1186/1471-2288-12-181
The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis
Flemmings, Kate and McInnes, Elizabeth. (2012) The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis. In In K. Haines and C. Lockwood (Ed.). Synthesizing qualitative research: Choosing the right approach pp. 59 - 82 John Wiley & Sons. https://doi.org/10.1002/9781119959847.ch4
Fostering Nursing Research
Walker, Kim. (2012) Fostering Nursing Research. Australian Nursing and Midwifery Journal. 19(7), pp. 36 - 36.
Preventing pressure ulcers-are pressure-redistributiong support surfaces effective?: A Cochrane systematic review and meta-analysis
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally, Dumville, Jo and Cullum, Nicky. (2012) Preventing pressure ulcers-are pressure-redistributiong support surfaces effective?: A Cochrane systematic review and meta-analysis. International Journal of Nursing Studies. 49(3), pp. 345 - 359. https://doi.org/10.1016/j.ijnurstu.2011.10.014
Preventing inadvertent hypothermia : comparing two protocols for preoperative forced-air warming
Cobbe, Kerry-Anne, Di Staso, Renatta, Duff, Jed, Walker, Kim and Draper, Nicole. (2012) Preventing inadvertent hypothermia : comparing two protocols for preoperative forced-air warming. Journal of PeriAnesthesia Nursing. 27(1), pp. 18 - 24. https://doi.org/10.1016/j.jopan.2011.10.005
A qualitative study of stakeholder views of the conditions for and outcomes of successful clinical networks
McInnes, Elizabeth, Middleton, Sandy, Gardner, Glenn, Haines, Mary, Haertsch, Maggie, Paul, Christine L. and Castaldi, Peter. (2012) A qualitative study of stakeholder views of the conditions for and outcomes of successful clinical networks. BMC Health Services Research. 12(1), pp. 1 - 12. https://doi.org/10.1186/1472-6963-12-49
Determinants of successful clinical networks: the conceptual framework and study protocol
Haines, Mary, Brown, Bernadette, Craig, Jonathan, D'Este, Catherine, Elliott, Elizabeth, Klineberg, Emily, McInnes, Elizabeth, Middleton, Sandy, Paul, Christine and Redman, Sally. (2012) Determinants of successful clinical networks: the conceptual framework and study protocol. Implementation Science. 7(16), pp. 1 - 10. https://doi.org/10.1186/1748-5908-7-16
Peri-operative nurses' knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study
Sutherland-Fraser, Sally, McInnes, Elizabeth, Maher, Elisabeth and Middleton, Sandy. (2012) Peri-operative nurses' knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study. BMC Nursing. 11(25), pp. 1 - 10. https://doi.org/10.1186/1472-6955-11-25
Preventing pressure ulcers -- Are pressure-redistributing support surfaces effective? A Cochrane systematic review and meta-analysis
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally, Dumville, Jo and Cullum, Nicky. (2012) Preventing pressure ulcers -- Are pressure-redistributing support surfaces effective? A Cochrane systematic review and meta-analysis. International Journal of Nursing Studies. 49(3), pp. 345 - 359. https://doi.org/10.1016/j.ijnurstu.2011.10.014
Preventing hypothermia in elective arthroscopic shoulder surgery patients: a protocol for a randomised controlled trial
Duff, Jeremy, di Staso, Renatta, Cobbe, Kerry, Draper, Nicole, Tan, Simon, Haliday, Emma, Middleton, Sandy, Lam, Lawerence and Walker, Kim. (2012) Preventing hypothermia in elective arthroscopic shoulder surgery patients: a protocol for a randomised controlled trial. BMC Surgery. 12(14), pp. 1 - 6. https://doi.org/10.1186/1471-2482-12-14
The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis
Flemmings, Kate and McInnes, Elizabeth. (2012) The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis. In In K. Haines and C. Lockwood (Ed.). Choosing the right approach pp. 59 - 82 John Wiley & Sons. https://doi.org/10.1002/9781119959847.ch4
Repositioning for pressure ulcer prevention in adults (Protocol)
Gillespie, Brigid, Chaboyer, Wendy, McInnes, Elizabeth, Kent, Bridie and Whitty, Jennifer. (2012) Repositioning for pressure ulcer prevention in adults (Protocol). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009958
End-of-life care in the intensive care unit: A systematic review of qualitative studies investigating the experiences and perceptions of the patient's families
Coventry, Alysia, McInnes, Elizabeth and Rosenberg, John. (2012) End-of-life care in the intensive care unit: A systematic review of qualitative studies investigating the experiences and perceptions of the patient's families. JBI Database of Systematic Reviews and Implementation Reports. 10, pp. 95 - 106. https://doi.org/10.11124/jbisrir-2012-177
Older people's views in relation to risk of falling and need for intervention: A meta-ethnography
McInnes, Elizabeth, Seers, Kate and Tutton, Liz. (2011) Older people's views in relation to risk of falling and need for intervention: A meta-ethnography. Journal of Advanced Nursing. 67(12), pp. 2525 - 2536. https://doi.org/10.1111/j.1365-2648.2011.05707.x
Case-loading midwifery in New Zealand: Bridging the normal/abnormal divide 'with woman'
Davis, D. and Walker, Kim. (2011) Case-loading midwifery in New Zealand: Bridging the normal/abnormal divide 'with woman'. Midwifery (print version). 27(1), pp. 46 - 52. https://doi.org/10.1016/j.midw.2009.09.007
Support surfaces for pressure ulcer prevention (Review)
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally E. M., Dumville, Jo C. and Cullum, Nicky. (2011) Support surfaces for pressure ulcer prevention (Review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001735.pub4
A study of 90-day outcomes for a cohort of patients admitted to an Australian metropolitan acute stroke unit
Jammali-Blasi, Asmara, McInnes, Elizabeth, Markus, Romesh, Faux, Steven, O'Loughlin, Grainne, Dale, Simeon and Middleton, Sandy. (2011) A study of 90-day outcomes for a cohort of patients admitted to an Australian metropolitan acute stroke unit. Journal of Vascular Nursing. 29(1), pp. 3 - 10. https://doi.org/10.1016/j.jvn.2010.11.004
Perioperative nursing shines! Magnet designation reflected in staff engagement, empowerment and excellence
Walker, Kim, Duff, Jed S., di Staso, R., Cobbe, K., Bailey, K., Pager, P. and Leathwick, S.. (2011) Perioperative nursing shines! Magnet designation reflected in staff engagement, empowerment and excellence. ACORN : The Journal of Perioperative Nursing in Australia. 24(3), pp. 34 - 42.
Support surfaces for treating pressure ulcers (Review)
McInnes, Elizabeth, Dumville, Jo C., Jammali-Blasi, Asmara and Bell-Syer, Sally E. M.. (2011) Support surfaces for treating pressure ulcers (Review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009490
Support surfaces for pressure ulcer prevention (Review)
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally, Dumville, Jo and Cullum, Nicky. (2011) Support surfaces for pressure ulcer prevention (Review). Cochrane Database of Systematic Reviews. 21(21-22), pp. 3195 - 3198. https://doi.org/10.1002/14651858.CD001735.pub4
Translating venous thromboembolism (VTE) prevention evidence into practice: A multidisciplinary evidence implementation project
Duff, Jed S., Walker, Kim and Omari, Abdullah. (2011) Translating venous thromboembolism (VTE) prevention evidence into practice: A multidisciplinary evidence implementation project. Worldviews on Evidence-Based Nursing (print version). 8(1), pp. 30 - 39. https://doi.org/10.1111/j.1741-6787.2010.00209.x
The corporeal, the social and space/place: Exploring intersections from a midwifery perspective in New Zealand
Davis, Deborah and Walker, Kim. (2010) The corporeal, the social and space/place: Exploring intersections from a midwifery perspective in New Zealand. Gender, Place and Culture: a journal of feminist geography. 17(3), pp. 377 - 391. https://doi.org/10.1080/09663691003737645
Who to turn to? Knowing the 'ropes' in an underbounded health care system
Chiarella, Mary and McInnes, Elizabeth. (2010) Who to turn to? Knowing the 'ropes' in an underbounded health care system. Contemporary Nurse. 36(February), pp. 10 - 20. https://doi.org/10.5172/conu.2010.36.1-2.010
Re-discovering the material body in midwifery through an exploration of theories of embodiment
Davis, Deborah and Walker, Kim. (2010) Re-discovering the material body in midwifery through an exploration of theories of embodiment. Midwifery. 26(4), pp. 457 - 462. https://doi.org/10.1016/j.midw.2008.10.004
Case-loading midwifery in New Zealand: Making space for childbirth
Davis, Deborah and Walker, Kim. (2010) Case-loading midwifery in New Zealand: Making space for childbirth. Midwifery. 26(6), pp. 603 - 608. https://doi.org/10.1016/j.midw.2009.01.004
Testing the effect of a targeted intervention on nurses' compliance with 'best practice' mechanical venous thromboembolism prevention
Li, Francesca, Walker, Kim, McInnes, Elizabeth and Duff, Jed. (2010) Testing the effect of a targeted intervention on nurses' compliance with 'best practice' mechanical venous thromboembolism prevention. Journal of Vascular Nursing. 28(3), pp. 92 - 96. https://doi.org/10.1016/j.jvn.2010.06.002
Nurses report a healthy culture: Results of the practice environment scale (Australia) in an Australian hospital seeking magnet recognition
Walker, Kim, Middleton, Sandy, Rolley, John and Duff, Jed. (2010) Nurses report a healthy culture: Results of the practice environment scale (Australia) in an Australian hospital seeking magnet recognition. International Journal of Nursing Practice. 16(6), pp. 616 - 623. https://doi.org/10.1111/j.1440-172X.2010.01890.x
Improving the safety and efficacy of warfarin therapy in a metropolitan private hospital: A multidisciplinary practice improvement project
Duff, Jed and Walker, Kim. (2010) Improving the safety and efficacy of warfarin therapy in a metropolitan private hospital: A multidisciplinary practice improvement project. Contemporary Nurse. 35(2), pp. 234 - 244. https://doi.org/10.5172/conu.2010.35.2.234
Celebrating connecting with communities: Coproduction in global primary health care
Chiarella, Mary, Savage, Jane and McInnes, Elizabeth. (2010) Celebrating connecting with communities: Coproduction in global primary health care. Primary Health Care Research and Development. 11(2), pp. 108 - 122.
In their own words: Support surfaces to prevent pressure ulcers
McInnes, Elizabeth. (2010) In their own words: Support surfaces to prevent pressure ulcers. Journal of Evidence-Based Medicine. 3(2), pp. 132 - 132. https://doi.org/10.1111/j.1756-5391.2010.01081.x
Letter: Evidence-based wound care in the UK: A response to David Leaper's Editorial in International Wound Journal April 2009 6(2)
Bell-Syer, Sally, Brady, Marian, Bruce, Julie, Cullum, Nicky A., Foxlee, Ruth, Jull, Andrew, Margolis, David, McInnes, Elizabeth, Nelson, Andre, O'Meara, Susan and Ubbink, Dirk. (2009) Letter: Evidence-based wound care in the UK: A response to David Leaper's Editorial in International Wound Journal April 2009 6(2). International Wound Journal. 6(4), pp. 306 - 309. https://doi.org/10.1111/j.1742-481X.2009.00620_1.x
Curriculum in crisis, pedagogy in disrepair: A provocation
Walker, Kim. (2009) Curriculum in crisis, pedagogy in disrepair: A provocation. Contemporary Nurse. 32(1-2), pp. 19 - 29. https://doi.org/10.5172/conu.32.1-2.19
Why fellowship? Peak professional bodies, peer recognition and credentialing in Australia
Middleton, Sandy, Walker, Kim and Leigh, Trina. (2009) Why fellowship? Peak professional bodies, peer recognition and credentialing in Australia. Collegian. 16(4), pp. 177 - 183. https://doi.org/10.1016/j.colegn.2009.06.002
Epilogue: nursing, gender, aporia
Walker, Kim. (2009) Epilogue: nursing, gender, aporia. Contemporary Nurse. 33(2), pp. 163 - 165. https://doi.org/10.1080/10376178.2009.11002401
A new framework to ensure excellence in patient-focused care. The nursing directorate's balanced scorecard approach
Aguillera, Jose and Walker, Kim. (2008) A new framework to ensure excellence in patient-focused care. The nursing directorate's balanced scorecard approach. Asia Pacific Journal of Health Management. 3(2), pp. 25 - 29.
Support surfaces for pressure ulcer prevention
McInnes, Elizabeth, Cullum, Nicky A., Bell-Syer, Sally, Dumville, Jo C. and Jammali-Blasi, Asmara. (2008) Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001735.pub3
The 'order of things': Tracing a history of the present through re-reading of the past in nursing education
Walker, Kim and Holmes, C. A.. (2008) The 'order of things': Tracing a history of the present through re-reading of the past in nursing education. Contemporary Nurse. 30(2), pp. 106 - 118. https://doi.org/10.5172/conu.673.30.2.106
Support surfaces for pressure ulcer prevention
McInnes, Elizabeth, Cullum, Nicky, Bell-Syer, Sally and Legood, Rosa. (2008) Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001735.pub2
An overview of the competency movement in nursing and midwifery
Tho, Debra, Chiarella, Mary, McInnes, Elizabeth and Lau, Cecilia. (2008) An overview of the competency movement in nursing and midwifery. Collegian. 15(2), pp. 45 - 53. https://doi.org/10.1016/j.colegn.2008.02.001
Using the qualitative assessment and review instrument (QARI) software to synthesise studies on older people's views and experiences of falls prevention
McInnes, Elizabeth and Wimpenny, Peter. (2008) Using the qualitative assessment and review instrument (QARI) software to synthesise studies on older people's views and experiences of falls prevention. International Journal of Evidence-Based Healthcare. 6(3), pp. 337 - 344.
Legality, morality and reality - the role of the nurse in maintaining standards of care
Chiarella, Mary and McInnes, Elizabeth. (2008) Legality, morality and reality - the role of the nurse in maintaining standards of care. Australian Journal of Advanced Nursing. 26(1), pp. 77 - 83.
A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions
Bunn, Frances, Dickinson, Angela, Barnett-Page, Elaine, McInnes, Elizabeth and Horton, Khim. (2008) A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions. Ageing and Society. 28(4), pp. 449 - 472. https://doi.org/10.1017/S0144686X07006861
Measuring the impact of a team model of nursing practice using work sampling
Walker, Kim, Donoghue, Judith and Mitten-Lewis, Suzanne. (2007) Measuring the impact of a team model of nursing practice using work sampling. Australian Health Review. 31(1), pp. 98 - 107. https://doi.org/10.1071/AH070098
Alert but not alarmed? The rhetoric of terrorism and life after 9/11.
Walker, Kim. (2006) Alert but not alarmed? The rhetoric of terrorism and life after 9/11. Contemporary Nurse. 21(2), pp. 267 - 273. https://doi.org/10.5172/conu.2006.21.2.267
Clinical practice guidelines for the assessment and prevention of falls in older people
McInnes, Elizabeth, Gibbons, Elizabeth and Chandler-Oatts, Jacqueline. (2005) Clinical practice guidelines for the assessment and prevention of falls in older people. Worldviews on Evidence-Based Nursing. 2(1), pp. 33 - 36. https://doi.org/10.1111/j.1524-475X.2005.04094.x
Developing a guideline on the use of pressure-relieving
Legood, Rosa and McInnes, Elizabeth. (2005) Developing a guideline on the use of pressure-relieving. Journal of Advanced Nursing. 50(3), pp. 307 - 314. https://doi.org/10.1111/j.1365-2648.2005.03394.x
The prevention of pressure ulcers
Rycroft-Malone, Jo and McInnes, Elizabeth. (2004) The prevention of pressure ulcers. Worldviews on Evidence-Based Nursing. 1(2), pp. 146 - 149. https://doi.org/10.1111/j.1741-6787.2004.04032.x
'Double b(l)ind': Peer-review and the politics of scholarship
Walker, Kim. (2004) 'Double b(l)ind': Peer-review and the politics of scholarship. Nursing Philosophy. 5(2), pp. 135 - 146. https://doi.org/10.1111/j.1466-769X.2004.00173.x
Evidence review on older people's views and experiences of falls prevention strategies
McInnes, Elizabeth and Askie, Lisa. (2004) Evidence review on older people's views and experiences of falls prevention strategies. Worldviews on Evidence-Based Nursing. 1(1), pp. 20 - 37. https://doi.org/10.1111/j.1741-6787.2004.04013.x
Developing national clinical practice guidelines :the NICE experience
McInnes, Elizabeth. (2004) Developing national clinical practice guidelines :the NICE experience. Implementing evidence based practice in nursing and midwifery. Adelaide, Australia: The Joanna Briggs Institute. pp. 73 - 76
The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care
McInnes, Elizabeth. (2004) The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. Journal of Tissue Viability. 14(1), pp. 4 - 23.
Evidence-based practice
Richens, Yana, Loftus-Hills, Alison and McInnes, Elizabeth Catherine. (2003) Evidence-based practice. In In S. Hinchliff, S. Norman and J. Schober (Ed.). Nursing practice and health care pp. 149 - 176 Hodder Arnold.
Why evidence-based practice now?: A polemic
Walker, Kim. (2003) Why evidence-based practice now?: A polemic. Nursing Inquiry. 10(3), pp. 145 - 155. https://doi.org/10.1046/j.1440-1800.2003.00179.x