Online Archive of University of Virginia Scholarship
Implementing Risk-Stratified VTE (Venous Thromboembolism) Prophylaxis Using IMPROVE (International Medical Prevention Registry on Venous Embolism) RAM (Risk Assessment Models): A Quality Improvement Initiative2 views
Author
Ko, Hyunsun, Nursing Practice - School of Nursing, University of Virginia
Advisors
Quatara, Beth, School of Nursing, UVA
Abstract
Background: Overuse of pharmacologic VTE (Venous Thromboembolism) prophylaxis in low-risk medical inpatients contributes to unnecessary bleeding risk and patient discomfort. The IMPROVE (International Medical Prevention Registry on Venous Embolism) VTE and IMPROVE-BLEED RAMs (Risk Assessment Models) to help guide prophylaxis based on risk levels.
Objective: To evaluate adherence to guideline-recommended VTE prophylaxis and project outcomes of implementing RAM-guided prophylaxis in hospitalized medical patients.
Methods: A retrospective chart review of 134 medical inpatients was conducted at an academic hospital during a 7-week period. Patients were stratified using IMPROVE VTE (≥2 = high increased risk) and IMPROVE-BLEED (≥7 = high bleeding risk) scores. Prophylaxis recommendations were categorized as follows: early ambulation for low VTE/low bleeding risk; pharmacologic prophylaxis for moderate VTE/low bleeding risk; and sequential compression devices for high VTE/high bleeding risk.
Results: Among 97 low-risk patients, 96% received sequential compression devices and/or pharmacologic prophylaxis despite guideline recommendations for early ambulation alone. The projected implementation of a RAM-based workflow would reduce interventions for low-risk patients from 70.1% to less than 1%.
Conclusions: Universal VTE prophylaxis results in substantial overtreatment of low-risk medical inpatients. Implementation of IMPROVE RAMs is projected to significantly reduce anticoagulant overuse while maintaining appropriate prophylaxis for higher-risk patients.
Implications for Nursing: Practice scholars can lead evidence-based practice changes that align VTE prophylaxis guidelines with individualized patient risk, improving safety and resource utilization.
Degree
DNP (Doctor of Nursing Practice)
Language
English
Rights
All rights reserved by the author (no additional license for public reuse)
Ko, Hyunsun. Implementing Risk-Stratified VTE (Venous Thromboembolism) Prophylaxis Using IMPROVE (International Medical Prevention Registry on Venous Embolism) RAM (Risk Assessment Models): A Quality Improvement Initiative. University of Virginia, Nursing Practice - School of Nursing, DNP (Doctor of Nursing Practice), 2026-04-30, https://doi.org/10.18130/zmc1-1411.