Venous Thromboembolism Prophylaxis: An Evidence-Based Practice Change

Purpose:
Venous thromboembolism (VTE) has been identified as an area of concern. In reviewing 58 charts it was noted that 41% of patients admitted to the medical center had no type of VTE prophylaxis ordered.Our goal was to implement a VTE Prevention Protocol with an integrated risk assessment model.

Significance:
VTE's are the most preventable cause of hospital death. Most hospitalized patients have risk factors with approximately 50-80% VTE's being asymptomatic. It is difficult to predict who will develop complications. Most VTEs/Pulmonary embolisms (PE) occur after discharge.

Strategy and Implementation:
Based on the evidence all patients should be assessed for their risk of a VTE or PE upon admission to the hospital and should receive some form of thromboprophylaxis. It was determined that standard use of prophylaxis reduces adverse outcomes. To aid in reducing adverse outcomes, upon admission and transfer, the nurse would perform a risk assessment and place a “note to provider” if the patient was at risk and no prophylaxis was ordered or the risk category has changed. Mechanical methods of thromboprophylaxis were used in patients at high risk of bleeding and as an adjunct to anticoagulant-based thromboprophylaxis for patients at moderate (optional) to high risk for DVT. If there were no contraindications the nurse would apply mechanical prophylaxis. The nurses developed a standardized Nursing Care Plan for continuity of care and a patient education handout. Patients are enourgaed to be active participants in exercise, ambulation, and the use of mechanical devices.

Evaluation:
A chart review revealed 79% of new admissions were risk stratified, patients identified as being at moderate or greater risk for VTE had with some form of prophylaxis 63%. Only 10% (down from 41%) of the patients that fell in the inclusion criteria had no form of prophylaxis treatment ordered.

Implications for Practice:
Interventions that when implemented would improve patient outcomes. Key components include: Formal risk assessment, all patients evaluated and risk stratified, computer based decision system, standardized order set, platelet count monitoring by protocol, and patient and family education.