Implementing Risk-Stratified VTE (Venous Thromboembolism) Prophylaxis Using IMPROVE (International Medical Prevention Registry on Venous Embolism) RAM (Risk Assessment Models): A Quality Improvement Initiative 109 views

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.

DNP (Doctor of Nursing Practice)

English

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2026-04-30