1. Residents at Boston
Medical Center General Internal
Medicine Department fail to follow
new Venous Thromboembolism
Guidelines
Materials
Resources
Methods
People
(Residents)
Limited resident knowledge in regards to
Novel Oral Anticoagulants due to demanding schedules
and self-driven study of residents. Residents experience
“guideline fatigue”, which is when they are given too
many guidelines to follow they lose track of the
latest practices.
Culture of automaticity in ordering
heparin due to resident education, which
is preventing change. This culture
is reinforced by attending discomfort
in supervising Novel Oral Anticoagulant
(NOAC) initiation.
Residents have comfort in common
practice because they are used to older
treatment protocol and are
concerned about insurance coverage
and costs of NOACs
Cost of Novel Oral Anticoagulants
varies and is greater than Heparin
Insurance may not provide
coverage for Novel Oral
Anticoagulants
2016 ACCP guidelines are new
and relatively unknown
Patients do not have access
Novel Oral Anticoagulants
Residents are inexperienced at choosing
Novel Oral Anticoagulants because the ACCP
guidelines are new and relatively unknown
No know algorithm for selection of
Novel Oral Anticoagulants. There is currently no order
set available to guide residents to choose NOACs
Novel Oral Anticoagulants
are a new method
to treat VTE
Novel Oral Anticoagulants are
infrequently prescribed
due to past cost issues
Novel Oral Anticoagulant
prescription lacks
standardized implementation
process
There is limited practical
knowledge of Novel Oral
Anticoagulants
Residents are not using optimum VTE
practice procedures
There are new 2016 American College of Chest
Physicians (ACCP) guidelines for treating
Venous Thromboembolisms (VTE)
Residents have been taught to prescribe Heparin
during their education. Until January 2016,
prescribing Heparin was the standard practice of care for
patients with VTE.
Lack of prescriptions of
Novel Oral Anticoagulants
The recommendation to use
Novel Oral Anticoagulants
is set out in new 2016
ACCP guidelines
Novel Oral Anticoagulants are
not prescribed to patients with
VTE
Limited resident knowledge
in regards to Novel
Oral Anticoagulants
The Root Causes of Problems in the Management of Venous Thromboembolisms (VTE) at Boston
Medical Center General Internal Medicine Department