On Monday, June 4, 2018, Paula M. Staggs, RN, CPHQ, CLHCP, assistant vice president of quality improvement for Martin Health System, and Kim Kinsey, RN, quality specialist for Central Florida Health, had the opportunity to present their organization's success with venous thromboembolism (VTE) prevention to a national audience during the HRET HIIN virtual event, STOP VTE: 1-2-3! Dr. Steve Tremain, physician improvement advisor for Cynosure Health, opened the presentation by reviewing the three "MUST DOs" for preventing VTE:
- Physicians use a standard VTE risk assessment tool. The most common qualitative tool is the modified '3 Bucket' or University of California San Diego Medical Center model. For those who want something more patient specific, the 'Caprini tool' is recommended. These tools can be found in the Agency for Healthcare Research and Quality (AHRQ) VTE Guide (Chapter 4).
- Risk drives orders. The risk tool chosen directly leads the physician to order those interventions that are appropriate for the determined risk.
- Nurses implement the orders with 100 percent adherence. Often patients do not welcome these orders, and nurses may not realize that any lapse increases the risk of VTE. Top performing hospitals educate the patients and nurses, track patient refusals by nurse, teach nurses how to respond to refusals and have strategies to ensure that the patient makes an informed choice.
Key takeaways shared by Martin Health System and Central Florida Health include:
- Know your data and what drives the VTE outcome for your patients
- Conduct an interdisciplinary gap analysis to identify process and practice opportunities
- Leverage EHR functionality with physician-driven VTE risk stratification and built in best practice" alerts and hard stops
- Implementation of a concurrent review and pre-billing analysis process
- Assign accountability of the health care team and monitor via documentation and observation to ensure orders are implemented without failure
- Adoption of an early progressive mobility program for reducing risk for VTE
- Ensuring availability of equipment for mechanical prophylaxis
- Education for patients and staff on VTE risk and interventions
- Share successes and celebrate
Visit FHA's Mission to Care HIIN Website for resources related to VTE:
FHA wishes to recognize and thank the Martin Health System and Central Florida Health teams for sharing their success stories. Their contribution has been very valuable in supporting others in reducing preventable post-operative VTE within our hospitals nationwide, as well as within communities across the state. Leveraging Electronic Health Record (EHR) systems, promoting early progressive mobility, implementing concurrent review processes and establishing clear guidelines for accountability reflect an ongoing commitment to providing safe patient care and improving outcomes.