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Implementing guidelines for risk-stratified thromboprophylaxis among gynecologic oncology patients: A quality improvement initiative.

Publication ,  Journal Article
Salinaro, JR; Zanolli, N; Truong, T; Havrilesky, LJ; Davidson, BA
Published in: Gynecol Oncol
January 2023

OBJECTIVE(S): Risk-stratified thromboprophylaxis is recommended for oncology patients with a Khorana risk score (KS) ≥ 2 receiving cancer-directed therapy. We describe a quality improvement (QI) initiative designed to increase adherence to thromboprophylaxis guidelines for patients with gynecologic malignancies initiating outpatient treatment. METHODS: Provider awareness and documentation of venous thromboembolism (VTE) risk assessment and thromboprophylaxis eligibility were identified as key QI drivers. Starting May 2021, a KS calculator and thromboprophylaxis algorithm were incorporated into outpatient documentation templates. Patients with gynecologic malignancies initiating outpatient therapy from January - December 2021 were eligible. The primary process measure was the percentage of patients with KS eligibility documented each month during the baseline (Jan - Apr) versus implementation (May - Dec) periods. Rate of appropriate thromboprophylaxis initiation and incidence of VTE served as outcome measures. Incidence of adverse bleeding events served as the balancing measure. RESULTS: 337 patients accounted for the initiation of 383 treatment regimens, including 128 in the baseline period and 255 in the implementation period. KS documentation increased significantly between the baseline and implementation periods (7% vs 62.4%, p < 0.001). 73 of the 177 eligible patients (46.2%; 166 unique patients) had appropriate documentation; of these, 57 initiated thromboprophylaxis. There was no difference in VTE rates or adverse bleeding events between eligible patients who initiated thromboprophylaxis compared with those who did not (12.3% vs 15.6%; p = 0.65 and 7.0% vs 8.2%; p = 1.0, respectively). CONCLUSION(S): This QI initiative resulted in greater adherence to risk-stratified thromboprophylaxis guidelines. No bleeding signals were identified. Studies addressing cost, medication adherence, and long-term outcomes are necessary.

Duke Scholars

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Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

January 2023

Volume

168

Start / End Page

144 / 150

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • Quality Improvement
  • Oncology & Carcinogenesis
  • Humans
  • Hemorrhage
  • Genital Neoplasms, Female
  • Female
  • Anticoagulants
  • 3215 Reproductive medicine
  • 3211 Oncology and carcinogenesis
 

Citation

APA
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ICMJE
MLA
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Salinaro, J. R., Zanolli, N., Truong, T., Havrilesky, L. J., & Davidson, B. A. (2023). Implementing guidelines for risk-stratified thromboprophylaxis among gynecologic oncology patients: A quality improvement initiative. Gynecol Oncol, 168, 144–150. https://doi.org/10.1016/j.ygyno.2022.11.016
Salinaro, Julia R., Nicole Zanolli, Tracy Truong, Laura J. Havrilesky, and Brittany A. Davidson. “Implementing guidelines for risk-stratified thromboprophylaxis among gynecologic oncology patients: A quality improvement initiative.Gynecol Oncol 168 (January 2023): 144–50. https://doi.org/10.1016/j.ygyno.2022.11.016.
Salinaro JR, Zanolli N, Truong T, Havrilesky LJ, Davidson BA. Implementing guidelines for risk-stratified thromboprophylaxis among gynecologic oncology patients: A quality improvement initiative. Gynecol Oncol. 2023 Jan;168:144–50.
Salinaro, Julia R., et al. “Implementing guidelines for risk-stratified thromboprophylaxis among gynecologic oncology patients: A quality improvement initiative.Gynecol Oncol, vol. 168, Jan. 2023, pp. 144–50. Pubmed, doi:10.1016/j.ygyno.2022.11.016.
Salinaro JR, Zanolli N, Truong T, Havrilesky LJ, Davidson BA. Implementing guidelines for risk-stratified thromboprophylaxis among gynecologic oncology patients: A quality improvement initiative. Gynecol Oncol. 2023 Jan;168:144–150.
Journal cover image

Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

January 2023

Volume

168

Start / End Page

144 / 150

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • Quality Improvement
  • Oncology & Carcinogenesis
  • Humans
  • Hemorrhage
  • Genital Neoplasms, Female
  • Female
  • Anticoagulants
  • 3215 Reproductive medicine
  • 3211 Oncology and carcinogenesis