Venous thromboembolism (VTE) risk assessment and prophylaxis: a comprehensive systematic review of the facilitators and barriers to healthcare worker compliance with clinical practice guidelines in the acute care setting

BackgroundEven though guidelines for venous thromboembolism risk assessment and prophylaxis are available, patients with identifiable risk factors admitted to acute hospitals are not receiving appropriate prophylaxis. The incidence of venous thromboembolism in hospitalized patients is higher than that of people living in the community who have similar demographics. Knowledge of barriers to healthcare professional compliance with clinical practice guidelines and facilitators to improve compliance will aid appropriate use of venous thromboembolism clinical practice guidelines.ObjectivesThe main objective of this review was to identify the barriers and facilitators to healthcare professional compliance with clinical practice guidelines for venous thromboembolism assessment and prophylaxis.Inclusion criteriaStudies were considered for inclusion regardless of the designation of the healthcare professional involved in the acute care setting.The focus of the review was compliance with venous thromboembolism clinical practice guidelines and identified facilitators and barriers to clinical use of these guidelines.Any experimental, observational studies or qualitative research studies were considered for inclusion in this review.The outcomes of interest were compliance with venous thromboembolism guidelines and identified barriers and facilitators to compliance.Search strategyA comprehensive, three-step search strategy was conducted for studies published from May 2003 to November 2011, aimed to identify both published and unpublished studies in the English language across six major databases.Methodological qualityRetrieved papers were assessed by two independent reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute.Data collectionBoth quantitative and qualitative data were extracted from papers included in the review using standardized data tools from the Joanna Briggs Institute.Data synthesisQuantitative data was pooled using narrative summary due to heterogeneity in the ways in which data was reported. Qualitative data was pooled using Joanna Briggs Institute software.ResultsTwenty studies were included in the review with methodological quality ranging from low to high.Reported compliance at baseline ranged from 6.25% to 70.4% and compliance post intervention ranged from 36% to 100%.Eight main categories of barriers and nine main categories of facilitators were identified. The quantitative and qualitative studies identified very similar barriers and facilitators which fell under the same categories. The studies all had components of education involved in their intervention and the review found that passive dissemination or one mode of intervention was not enough to affect and sustain change in clinical practice.ConclusionsThis review identified 20 studies that assessed compliance with venous thromboembolism clinical practice guidelines, and identified barriers and facilitators to that compliance. The studies showed that many different forms of intervention can improve compliance with clinical practice guidelines. They provided evidence that interventions can be developed for the specific audience and setting they are being used for, and that not all interventions are appropriate for all areas, such as computer applications not being suitable where system capacity is lacking.Healthcare professionals need to be aware of venous thromboembolism clinical practice guidelines and improve patient outcomes by using them in the hospital setting. There are a number of interventions that can improve guideline compliance, keeping in mind the barriers and adjusting practice to avoid them.Venous thromboembolism compliance within rural Australian hospitals has not been determined, however as inequalities have been identified in other areas of healthcare between urban and rural regions this would be a logical area to research.Sherryl Gaston, Sarahlouise White, Gary Misa