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Thromboprophylaxis in a Pediatric Hospital: A Patient-Safety and Quality-Improvement Initiative

OBJECTIVES: Venous thromboembolism (VTE) prophylaxis for patients at risk is often overlooked in pediatric health care institutions, which provides an opportunity to improve patient care. The objectives of this study were to review our current hospital practice, identify a population at high risk, and formulate institutional guidelines for thromboprophylaxis. METHODS: This was a prospective patient-safety and quality-improvement project performed at a large pediatric tertiary care hospital. We developed criteria for assessing risk and selecting prophylactic intervention through analysis of the age distribution and underlying medical conditions of patients with VTE at our center, literature review of adult recommendations for thromboprophylaxis, and consensus opinion of multiple specialists at our institution. A patient-care policy was developed to assess VTE risk and prescribe the appropriate thromboprophylaxis regimen. The primary outcome measure was compliance with thromboprophylaxis guidelines in patients at risk for VTE. RESULTS: Over the 4-year study period, the observed rate of VTE prophylaxis in patients at risk increased from a baseline of 22% to an average rate of 82%, and there were intermittent improvements up to 100%. CONCLUSIONS: Although some of the details may vary from center to center, many of the discussed principles and practices involved in instituting a VTE-prevention program are applicable to other pediatric institutions. Despite the fact that the risk of VTE in hospitalized children is much lower than that in adults, there are patients in pediatric hospitals who deserve systematic screening and thoughtful application of preventative measures.