Improving inpatient venous thromboembolism prophylaxis.

OBJECTIVES: The number and types of inpatients given inadequate prophylaxis for venous thromboembolism (VTE) are not known; patients receive less than appropriate prophylaxis with some frequency. METHODS: Initially we evaluated VTE prophylaxis at a community hospital by comparing prophylaxis patterns in adult inpatients for whom some prophylaxis was indicated. Patients were categorized as medical, general surgery, and orthopedic, then categorized as "appropriate," "suboptimal," or "none" in terms of VTE prophylaxis. After initial data collection, we performed an intervention on medical patients using a VTE risk assessment tool; a printed evaluation containing the VTE risk assessment score with related VTE prophylaxis regimens was placed in the patients' charts, after which prophylaxis patterns were compared between preintervention and postintervention medical patients. RESULTS: Initial data collected from 116 medical, 110 general surgery, and 72 orthopedic patients (n = 298) showed that there was a significant association between diagnosis category and level of observed appropriate VTE prophylaxis (P < 0.0001). Fifty-six medical patients (48%) received no prophylaxis, compared to 40 (36%) general surgery patients and 12 (17%) orthopedic patients. In the second phase, 74 medical patients on whom the intervention was performed were compared to 116 preintervention medical patients (n = 190). The findings showed that intervention status had a significant association with level of appropriate VTE prophylaxis (P < 0.0001). CONCLUSION: An increase in appropriate VTE prophylaxis was observed after a system-level intervention.

Diagnosis and treatment of migraine in the patient with depression.

BACKGROUND AND PURPOSE: Migraine headache is an enormous health care burden resulting in billions of dollars in workforce revenue lost and millions of lost workdays per year. Migraine headaches and depression are common comorbidities and require expertise in treatment and prevention. METHODS: The aim of this article is to update the nurse practitioner (NP) on best clinical practices for managing the patient with migraine and previously diagnosed depression. This will include an overview of the pathophysiology of migraine, as well as criteria for diagnosis, treatment, prevention, and patient teaching. CONCLUSIONS: Migraine and depression are commonly linked and require expertise in treatment to achieve the best patient outcomes. IMPLICATIONS FOR PRACTICE: Patients with migraine are more likely to have depression than the general population. Both conditions require optimal treatment and patient education to reduce overall disease burden. A better understanding of the relationship between depression and migraine will enable the NP to better manage patients with migraine and comorbid depression.