Department of Health Skip to content

Please note that this website has a UK government access keys system.

You are here:

IMP 17-13 Grimshaw: Prevention of deep vein thrombosis: A feasibility study for a randomised trial of three different strategies to implement evidence based guidelines

  • Last modified date:
    8 February 2007
Lead researcher: Professor Jeremy Grimshaw (Health Services Research Unit, Aberdeen)

EXECUTIVE SUMMARY

PROJECT FINDINGS

Background
Deep vein thrombosis of the lower limb (DVT) and its acute complication, pulmonary embolism (PE) are major causes of death and disability in developed countries. Routine prophylaxis in moderate or high-risk groups is the most efficient management option. Published audits in UK and US hospital settings suggested that high-risk patients were not receiving prophylaxis.

Objectives
To evaluate the effectiveness and efficiency of three different dissemination and implementation strategies for evidence based guidelines for the prevention of deep vein thrombosis.

Design
2 x 2 x 2 factorial cluster randomised controlled trial. One-year feasibility study undertaken. Details of intervention: Guideline - national guidelines for prophylaxis of deep vein thromboembolism based on systematic review, developed by multi disciplinary group and evidence-linked recommendations. Interventions -

i. Educational outreach visits to ward staff,
ii. Reminder systems at the time of consultation;
iii. Role substitution involving nursing or pharmacy staff assessing patients' risk status.

Settings
Up to 66 clinical directorates in acute NHS trusts in Scotland and northern England.

Study participants
Health care workers in hospital settings - senior and junior doctors, nurses, pharmacists.

Main outcome measures
Data collected by case not review from pre and post intervention cohort of medium and high risk patients identified from routine discharge data. Principal outcome is proportion of patients receiving thromboprophylaxis. Additional information for economic evaluation from case note review, published data, standard unit costs and expert opinion. Prospective assessment of barriers during the feasibility study period. Monitoring of implementation strategies.

Results
Feasibility study completed involving recruitment of over 17 hospitals, widespread interest in trial expressed by other hospitals; methods of data collection proven; survey of barriers using 'Theory of Planned Behaviour' framework completed. Baseline prophylaxis rates higher than expected (>90% in surgical directorates, 75% in medical directorates).

Conclusions
NHS trusts are willing to participate in trials of guideline implementation strategies. Baseline prophylaxis rates suggest a high level of guideline compliant practice. Main trial abandoned because rates of prophylaxis are too high to demonstrate a statistically significant improvement in the trial.

RELEVANCE TO THE NHS

Trusts currently providing high levels of DVT prophylaxis. Widespread interest within NHS trusts to participate in multi site rigorous evaluations of dissemination and implementation strategies.

DISSEMINATION

Target audience: academic and professional, NHS trusts.

Publications
Implementation of a National Guideline on Prophylaxis of Venous
Thromboembolism: A Survey of Acute Services in Scotland
Walker, AE., Campbell, SE., Grimshaw, JM., & The TEMPEST Study Group.
Health Bulletin. 1999;57:141-147
When Do Clinicians Follow Guidelines? Using the Theory of Planned Behaviour to Predict Intentions to Prescribe Prophylaxis for Patients at Risk of Deep Vein Thrombosis
Walker, AE., Johnston, M., Grimshaw, JM., Abraham, SCS., Campbell, MK., & The TEMPEST Study Group.
Journal of Epidemiology and Community Health. 1998;52(10):676
Effective Professional Practice and the Theory of Planned Behaviour
Walker, AE., Johnston, M., Abraham, SCS., Grimshaw, JM., & The TEMPEST Trial Group.
European Health Psychology Society CD-ROM, 1998

Contact details for final report:
Professor Jeremy Grimshaw,
Health Service Research Unit,
University of Aberdeen,
Medical School, Foresterhill,
Aberdeen AB25 2ZD.

Tel: 01224 553 968,
Fax: 01224 663 087

Access keys