A unit-based intervention aimed at improving XXXX adherence to pharmacological thromboprophylaxis.

@entity1 @entity1211
BACKGROUND: Pharmacological thromboprophylaxis is necessary among many hospitalised @entity1 to prevent @entity1211 ( @entity1211 ). However, a significant number of clinician-ordered doses are not administered with many doses refused by @entity1 . We aimed to assess the impact and sustainability of a multifaceted intervention to improve medication adherence to pharmacological thromboprophylaxis. The intervention included a standardised nursing response to @entity1 refusal, daily assessment of @entity1211 prophylaxis usage and regular feedback on refusal rates. METHODS: We conducted a quasi-experimental study of @entity1 admitted between January 2010 and November 2012 to one of six hospital intervention units (three medical and three oncology units) or five control units. The primary outcome was the proportion of @entity1211 prophylaxis doses missed for any reason. RESULTS: A total of 20   208 admissions occurred at the six hospital units during the study period. In the pre-post analysis, the rate of missed and refused doses decreased significantly after the intervention (24.7% to 14.7% and 18.3% to 9.4%, respectively; p value <0.01 for both comparisons). In multiple regression models with interrupted time series analysis, the intervention was associated with an immediate and sustained decrease in missed (adjusted OR 0.64; 95% CI 0.55 to 0.74 and 0.98; 95%CI 0.97 to 0.99) and refused doses (adjusted OR per month 0.58; 95% CI 0.48 to 0.71 and 0.97; 95%CI 0.96 to 0.98). No immediate or sustained reduction in missed or refused doses was observed in the control units. CONCLUSIONS: Implementation of a multifaceted intervention resulted in an immediate and sustained decrease in the proportion of missed and refused doses of pharmacological thromboprophylaxis. Efforts aimed at increasing @entity1 adherence are a promising approach to improve rates of @entity1211 thromboprophylaxis administration.
