Challenge 12

Venous Thromboembolism (VTE)

Executive Summary Checklist

In order to establish a program to eliminate Venous Thromboembolism (VTE), an implementation plan with the following actionable steps is recommended as best practice science to reduce patient harm. The following core action items and prevention strategies are outlined below using an interdisciplinary, best practice approach:

  • Hospital governance and senior administrative leadership must champion efforts in raising awareness around the high incidence of VTEs and prevention strategy measures.
  • Healthcare leadership should support the design and implementation of standards and provider training programs on VTE reduction and prevention strategies by:
    • Accurately stratifying risk by ensuring that providers perform a VTE Risk Assessment
    • Measure appropriate quality measures related to VTE to close performance gap
    • Complete in depth chart review for hospital-associated thrombosis events to identify opportunities for improvement and then acting on lessons learned
    • Adhere to VTE best practices from national organizations such as Agency for Healthcare Research and Quality’s VTE Safety Toolkit.1 The toolkit contains 10 components that are evidence-based guidelines for preventing, diagnosing, treating, and educating patients and providers about VTE.                                               The components are as follows:
      • VTE prophylaxis guidelines, VTE risk assessment tool, DVT diagnostic algorithm, PE diagnostic algorithm, HIT (heparin-induced thrombocytopenia) assessment, VTE treatment pathway, DVT outpatient treatment order set, Vascular laboratory requisition, Neural-axial anesthesia guidelines, Patient education (prevention and treatment) pamphlets
    • Ensure healthcare professionals receive, at the least, annual training on new VTE policies and processes
  • Assess risk for VTE among patients hospitalized with:
    • Injury to vein: fracture, surgery
    • Slow blood flow: bedrest, limited mobility, paralysis
    • Increased estrogen: birth control, pregnancy and recent childbirth, hormone replacement therapy
    • Chronic illness: cancer, heart/lung disease, atrial fibrillation, inflammatory bowel disease (Chrohn’s and Ulcerative Colitis)
    • Other: personal or family history of DVT/PE, age, obesity, central lines, or clotting disorders
  • Educate patient and families on VTE risks, complications, and importance of mechanical and medication prophylaxis.
  • Select technologies that show early evidence to reduce VTEs and positively impact both patient and provider outcomes in the clinical settings
    • Implement an EHR with prompt decision making support to ensure that every patient has a valid VTE prevention plan in place at all times during their hospitalization.

Between the 2017 World Patient Safety, Science & Technology Summit and the 2017 Midyear Planning Meeting a workgroup comprised of experts representing administrators, clinicians, technologists and patient advocates will meet to update this APSS. If you are interested in joining this workgroup, please email us.

References
  1. Agency for Healthcare Research and Quality. (2016). Preventing Hospital-Associated Venous Thromboembolism.Retrieved from: http://www.ahrq.gov/professionals/quality-patient-safety/patient-safetyresources/resources/vtguide/index.html