Leadership Plan
Identify: Senior executive leadership that is committed to a reduction in VTE
- Team ideally is led by a physician and administrative champions, ideally the Chief Nursing Officer
- Gather staff that have an in-depth knowledge base of disease process and prevention of VTE such as:
- Physicians
- Nursing Leaders
- Advance Practice Providers such as Physical and Occupational Therapists
- Physicians in training
- Residents
- Bedside Nurses
- Quality Improvement staff
- Safety/Risk
- Pharmacy
- Information Technology team with Electronic Medical Record
Plan: Senior executive leadership and clinical /safety leaders should agree on the best implementations in order to close their performance gap.
- Plan should include measurable appropriate quality metrics
Timeline set: Senior executive leadership should select a goal and set a timeline to achieve said goal.
Resources allocated: Senior executive leaders should set specific budget for said goal and plan
System leadership and engagement: Clinical and safety leaders should act as change agents and drive implementation
Practice Plan
Complete in depth chart review of hospital-associated thrombosis events. Identify trends such as:
- Service line
- Physician
- Diagnosis
- Risk score (Appendix A: Caprini Score, Padua Prediction Score, IMPROVE score, or “3-bucket”model)
- Hospital units
- Pharmacological prophylaxis ordered
- Pharmacological prophylaxis missed doses
- Patient Refusal of pharmacological prophylaxis
- Mechanical prophylaxis ordered
- Patient refusal of mechanical prophylaxis
Identify gaps in care that promote VTE development
Adhere to the Agency for Healthcare Research and Quality’s Venous Thromboembolism Safety Toolkit: A System’s Approach to Patient Safety
Implement interventions that reduce VTE
- Ensure interventions are patient-centered
- Incorporate VTE Risk Assessment into EHR for all new admissions
- Reassess risk periodically upon change in level of care, clinicians, and prior to discharge.
- Ensure the ordering of appropriate VTE prophylaxis according to risk assessment and BMI
- Consider adoption of VTE power plans/order sets
- Continue VTE prophylaxis past discharge if recommended
- Ensure timely and reliable delivery of pharmacological and/or mechanical prophylaxis as indicated
- Track/trend missed doses, patient refusals and ensure that patient resistance or refusal is met with education about the purpose of prophylaxis and risks if not administered.
- Develop specific and reliable protocols, endorsed by local surgical champions, for reliable mechanical or pharmacologic prophylaxis to be applied prior to induction of anesthesia, as appropriate
- Consider nursing protocol for application of mechanical prophylaxis in pre-op areas
- Understand your staff’s perception of the importance of VTE prophylaxis
- Educate knowledge deficits
- Consider yearly competence in VTE
- Ensure that all team members - physicians, nurses, patient care assistants, trainees, pharmacists, transport personnel, physical therapists, patients and family members are aware of their role in VTE-P.
- Patient Mobility
- Utilize mobility trackers
- Design and implement a plan when pharmacological prophylaxis is contraindicated, such as proactive monitoring.
Educate patients and families about the risks, complications, the importance of VTE prophylaxis, and the symptoms of DVT and PE.