VTE - It's Easy as 1-2-3

Purpose:
The goal of this initiative was to decrease Venous Thromboembolism (VTE) occurrences through increased use of evidence based guidelines, incorporation of multiple indicators and the application of professional organization standards for VTE prevention.

Relevance/Significance:
Adverse events related to VTEs are common and problematic, leading to poor clinical outcomes and prolonged hospital stays. The presenters, both Clinical Improvement Specialists, noted an increase in VTE complications amongst their patient populations. They analyzed data and collaborated under the direction of the Interim Director of Quality. They co-lead the initiative and successfully disseminated and implemented best practices in evidence-based, inter-professional, patient-centered care.

Strategy and Implementation:
The strategy was to incorporate a hospital wide process improvement utilizing the Plan, Do, Check, Act (PDCA) methodology. The PDCA provided for a focused and well monitored PI that would ultimately increase patient safety. The implementation included: education and increasing awareness of VTE, interdisciplinary involvement and ongoing monitoring. The education and promotion of the VTE project was presented to all staff including, but not limited to: medical staff, residents, midlevel providers, pharmacy, nursing, quality, clinical transformation, hospital administration, and select board members. The education included a customized PowerPoint presentation and a 'sing along'. The catchy jingle reinforced VTE prevention. V-T-E … It's easy as 1-2-3! … It's up to you and me, VTE! 1-2-3! Patient, you and me! Yeah! Additional actions included better utilizing EMR to facilitate ordering prophylaxis or documenting contraindications and communication amongst healthcare providers.

Evaluation:
This was a successful hospital-wide performance initiative regarding VTE prevention. Significant improvements were realized comparing data from Q3 2012 to Q3 2013. The cumulative rate for surgical patients went from 2.4% to 0.6% and for medical patients from 2.78% to 0.84%. Both populations were at three times the state mean and were reduced to at or below the average in one year's time.

Implications for Practice:
Clinical practice changes resulted. Knowledge and understanding related to the prevalence of VTE and importance of prophylactic measures, as well as contraindications, have improved nursing care. RNs provide improved patient education related to VTE prevention resulting in improved compliance.