By Edwin Loftin, DNP, MBA, RN, NEA-BC, FACHE
One person dies every six minutes from a preventable blood clot. That is a staggering statistic. The total number of deaths from blood clots each year (estimated to be in the 100,000 to 300,000 range) is greater than the total number of people who lose their lives each year to AIDS, breast cancer, and motor vehicle crashes combined.
You’ve probably heard about tennis superstar Serena Williams and how she survived blood clots after the delivery of her first child. We learned she previously had a pulmonary embolism (a blood clot that traveled to her lungs) in 2011, so many assumed that only certain people that are predisposed to get blood clots are at risk. There are a number of conditions, and medications that increase the likelihood of someone developing a clot but the reality is that anyone can be affected by a blood clot regardless of age or condition.
The good news is that the literature and evidence is strong in defining how to prevent blood clots from ever occurring in the healthcare setting. The challenge is to assure all clinicians and healthcare organizations follow the evidence-based standard practices. Proper implementation of these proven patient/person-centered safety processes is key to preventing injury or death from clots. The Patient Safety Movement Foundation outlines a set of proven processes in their of Actionable Patient Safety Solutions (APSS) #12A specific to Venous Thromboembolism (VTE).
The solution includes several straightforward steps that must be followed at all times. These include:
- Ensure that providers perform a VTE risk assessment that accurately stratifies risk
- 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 (Crohn’s Disease 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 the importance of mechanical and medication prophylaxis
- Ensure staff comply with VTE prophylaxis modalities based on VTE risk assessment including:
- Medication prophylaxis (such as anticoagulants)
- Mechanical prophylaxis (such as compression therapy)
- Patient mobility
APSS #12 includes references to several evidence-based resources including the AHRQ tool kit. This tool kit addresses risk assessment as well as prevention methods. It’s important to not take these steps as a suggestion and to follow them precisely.
It sounds easy enough but a big challenge that we need to overcome is that the quality measures used by many hospitals does not take into account preventable harm and death. The quality measures often skip one or two vital steps such as missed doses or lack of intentional mobility. And if the right things are not being measured, the hospital’s ability to improve its processes becomes greatly impaired. Once the proper processes are in place and being followed to precision, the steps outlined above need to be continually measured so VTE is prevented at all times. We can’t improve what we can’t measure.
There are so many issues in healthcare that we don’t have an exact solution for but for VTE/blood clots, we know exactly what needs to be done; we now just have to do it.