Improving the Use of Venous Thromboembolism Prophylaxis during the Postpartum Period
Nature and scope of the project
Venous thromboembolism (VTE) is one of the leading causes of maternal morbidity and mortality in the United States accounting for 9.3% of all maternal deaths. Postpartum patients have a fourfold to fivefold increased risk for VTE specifically within the first four to six weeks after delivery.
Synthesis and analysis of supporting literature
Thrombolytics, specifically low molecular weight heparin, have been shown to reduce the risk of thromboembolism rates in patients who demonstrate risk factors. One of the barriers to VTE prophylaxis is underprescribing by obstetrical providers which increases the risk for maternal morbidity and mortality. The purpose of this quality improvement project was to improve the prescribing of low molecular heparin for postpartum individuals at risk for developing life-threatening venous thromboembolism.
Project implementation
Project implementation took place at a large, academic medical center on Chicago’s west side. Multifactorial interventions included a comprehensive educational in-service for obstetrical healthcare providers on the importance of prescribing postpartum low-dose heparin. The introduction of a paper-based risk assessment tool was integrated at each workstation serving as a reminder of who qualified for postpartum VTE prophylaxis. Integration of best practice alert in the electronic medical record was also implemented prompting obstetrical providers to prescribe low-dose heparin if clinically indicated.
Evaluation criteria
Comprehension of the educational in-service content was evaluated with pre/post-test evaluation to assess their knowledge of the importance of prescribing of low molecular heparin. Data was retrieved from the electronic medical comparing pre- and post-intervention prescribing rates from 2022 and 2023 to determine if the strategic interventions improved overall rates.
Outcomes
These multi-component strategies improved VTE prophylaxis prescribing rates from 42% to 81%. The obstetrical provider’s knowledge and confidence significantly increased pre/post-intervention. By improving postpartum venous thromboembolism prescribing rates, this quality improvement project was able to improve health outcomes and preventable causes of maternal death.
Recommendations
Multicomponent, quality improvement strategies such as educational in-services, a paper-based risk assessment tool and best practice alerts in the electronic medical record have the ability to increase thromboembolism prophylaxis prescribing in the postpartum period which is one step closer to improving the maternal health crisis in the United States.
Improving the Use of Venous Thromboembolism Prophylaxis during the Postpartum Period