Improving the adoption of optimal venous thromboembolism prophylaxis in critically ill patients: A process evaluation of a complex quality improvement initiative

J Crit Care. 2019 Apr;50:111-117. doi: 10.1016/j.jcrc.2018.11.023. Epub 2018 Nov 29.


Purpose: This study evaluated a complex initiative to increase evidence-based use of low molecular weight heparin for venous thromboembolism prophylaxis among adult medical-surgical ICU patients.

Materials and methods: This study included: quantitative survey and interviews. Participants were healthcare providers within four ICUs. Surveys collected knowledge of evidence underpinning best practice, exposure to the implementation strategies and their perceived utility, and recommendations. The interview expanded on survey topics. Descriptive statistics summarized the data and chi-squared tests were used to compare groups. Qualitative data were analyzed using a blended deductive and inductive coding approach.

Results: Providers had good knowledge of the evidence (range = 58% to 94%). Pharmacist-to-physician reminders (80%), other reminders (50%), and local guidelines (50%) were the most commonly observed strategies. Local champions (76%), on-site education (74%), and computerized decision support system (69%) were perceived to be most helpful. Interviews elicited five themes: provider roles, perceptions of the implementation strategies, facilitators and barriers to uptake of best practice, and recommendations. Assessment of the implementation strategies varied by professional group.

Conclusions: The findings of this process evaluation identified implementation strategies that can improve the use of evidence-informed practices, help interpret outcomes in the context of interventions and guide future quality improvement initiatives.

Keywords: Behavior change; Evidence-based medicine; Health services research; Knowledge measurement; Program evaluation; Quality of care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use*
  • Critical Illness / therapy
  • Cross-Sectional Studies
  • Decision Support Systems, Clinical
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Heparin, Low-Molecular-Weight / therapeutic use*
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Process Assessment, Health Care
  • Quality Improvement
  • Venous Thromboembolism / drug therapy*


  • Anticoagulants
  • Heparin, Low-Molecular-Weight