Transcript VTE Prophylaxis

VTE Prophylaxis
Alert to providers and nursing
Go live June 24, 2014
VTE Prophylaxis – why do it?
• The estimated annual incidence of deep-vein thrombosis
(DVT) and pulmonary embolism (PE), known collectively as
venous thromboembolism (VTE), is approximately 900,000
(Geerts, et al, 2008). Approximately two-thirds of cases of DVT
or PE are associated with recent hospitalization. This is
consistent with the 2001 report by The Agency for Healthcare
Research and Quality (AHRQ). AHRQ indicates that “the
appropriate application of effective preventive measures in
hospitals has major potential for improving patient safety by
reducing the incidence of venous thromboembolism”
(Shojania, 2001).
VTE Prophylaxis – why do it?
• Despite its proven effectiveness, rates of appropriate
thromboprophylaxis remain low in both medical and surgical
patients. A recent analysis from the ENDORSE survey, which
evaluated prophylaxis rates in 17,084 major surgery patients, found
that more than one third of patients at risk for VTE (38%) did not
receive prophylaxis and that rates varied by surgery type (Cohen, et
al., 2008).
• In a review of evidence-based patient safety practices, the Agency
for Healthcare Research and Quality defined thromboprophylaxis
against VTE as the "number one patient safety practice" for
hospitalized patients (Shojania, 2001). Updated “safe practices”
published by the National Quality Forum (NQF) recommend routine
evaluation of hospitalized patients for risk of VTE and use of
appropriate prophylaxis (National Quality Forum. National Voluntary
Consensus Standards for Prevention and Care of Venous
Thromboembolism, 2006).
• (Taken from eCQMs for EH’s updated April 2014)
INTEGRIS Data for VTE Quality
Measure 2013
VTE Prophylaxis in the EMR current state
• On admission, the VTE prophylaxis needs to be addressed.
• Either an order for pharmacologic prophylaxis, an order for mechanical prophylaxis,
or documentation of a contraindication to the VTE Prophylaxis.
• This order should be based on the patient’s risk for developing a VTE.
• Orders can be placed via the orders tab or through the Order link on the widget. The
admission PowerPlans have VTE prophylaxis orders embedded within them for easy
ordering.
• Contraindication must be charted from the link on the widget.
VTE Prophylaxis Alert - new
• If the patient has been
admitted for 8 hours, and
orders for VTE Prophylaxis
have not been placed nor
documentation of the
contraindication, the alert
will fire to the provider
when signing an order
notifying them that an
order needs to be placed
or to document the
contraindication.
• Orders for VTE prophylaxis
may be placed inside the
alert window.
VTE Prophylaxis Alert
• The ‘document’ link in the
alert will open the VTE
Prophylaxis contraindication
PowerForm.
VTE Prophylaxis Alert
• The alert will continue to fire
for 48 hours after admission
or until the orders have been
placed or the documentation
of the contraindication is
complete.
• Additional VTE risk factors will
be displayed if documented in
the record. Those being
diagnosis or problem of
cancer or previous VTE
(DVT/PE), BMI greater than
30, smoker, age 60 or greater
and home medication of
estrogen.
• If the patient has a higher risk
factor (s), pharmacological
agents should be considered.
VTE Prophylaxis Alert – surgical
patients with neuraxial anesthesia
• Patients that have surgery with neuraxial anesthesia are more
prone to bleeding, therefore, the alert will not fire for 24
hours after anesthesia end time.
• Neuraxial anesthesia is documented in the perioperative
record. It will be documented as “epidural”, “spinal”, “caudal”,
“general/epidural”, “general/intrathecal” and “intrathecal”.
VTE Prophylaxis Nurse Alert
• If there is an active order for Sequential
Compression Device (SCD), and nursing has
not completed the documentation in Iview,
the nurse will receive an alert when
opening the patient record.
• Nursing may click on the document link
and a PowerForm will open to document
the SCD’s. This information will flow to
Iview.
• The alert will begin after the patient has
been admitted for 10 hours and will
continue until documentation has occurred
or for 48 hours after admission.
References
• Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR,
Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP
Conference on antithrombotic and thrombolytic therapy. Chest. 2008;
133:381S-453S
• Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk
and prophylaxis in the acute hospital care setting (ENDORSE study): a
multinational cross-sectional study. Lancet. 2008;371:387-394.
• Shojania KG, Duncan BW, McDonald DM, et al. (Eds.). (2001). Making
healthcare safer; A critical analysis of patient safety practices (Evidence
Report/Technology Assessment No. 43). Prepared by the University of
California at San Francisco-Stanford Evidenced-based Practice Center
under Contract no. 290-97-0013 (AHRQ Publication NO.01-E058).
Rockville, MD:Agency for Healthcare Research and Quality.
• National Quality Forum. National Voluntary Consensus Standards for
Prevention and Care of Venous Thromboembolism: Policy, Preferred
Practices, and Initial Performance Measures. A Consensus Report.
Washington, DC. NQF; 2006