5600 Fishers Lane Certain key elements, such as weight and creatinine clearance, were pulled into the order set and made available to the ordering provider at the point of care. A nurse could, for example, be asked to chart each shift whether IPCD was on or off and, if off, a pull-down menu could capture the reason. Analyzing care delivery, assessing and addressing barriers, and ongoing measurement and monitoring are also essential. 7G�"�ff`�M�L�3�� G�I��@�` ��$� • Protocols that standardize VTE risk assessment and prophylaxis. Meeting with the CPOE and/or the information technology team early and often about order set design and how to make measurement an integral part of the process can help. Important steps included summarizing the evidence from a centralized steering group; identifying barriers through pilot testing, good measurement, and feedback; and reinforcing appropriate prophylaxis through staff engagement, education, regular evaluation, good clinical decision support in order sets, and layered interventions to reinforce the protocol.6, The Johns Hopkins team created VTE prevention decision algorithms for 16 distinct service groups (medicine, general surgery, trauma, and so forth) and integrated those algorithms into "smart" order sets. Skilled implementation can overcome the weakness of a suboptimal VTE prevention protocol; similarly, flawed implementation of an excellent VTE prevention protocol will result in mediocrity and failure to reach the goal of reducing hospital-associated VTE (HA-VTE). It must be embedded in patient care. As both study medications are currently in clinical use for VTE prophylaxis for orthopaedic trauma patients, the findings of this trial can be easily adopted into clinical practice. After reviewing the evidence and selecting a venous thromboembolism (VTE) risk assessment model, the improvement team will begin gearing up for the all-important implementation phase. V enous thromboembolism (VTE) affects as many as 600,000 Americans every year, with an estimated 100,000 fatalities annually. A VTE prevention protocol includes a VTE risk assessment, bleeding risk assessment, and clinical decision support (CDS) on prophylactic choices based on … For some risk factors or contraindications, it may help to auto-populate data elements from elsewhere in the record. VTE is a condition in which a blood clot (a thrombus) forms in a vein. Patient may have multiple risk factors that are offset Taking an order set out for a "test drive" is far more effective, however, when the pilot risk assessment and order set are applied to patient case scenarios, as ease of use and issues of ambiguity become much more apparent. Johns Hopkins Internal Medicine used several of the key principles of CDS. The comprehensive implementation effort included deployment of the CDS principles in reinforcing the medical center's VTE prevention protocol. Almost always, simpler is better and less is more. The potential public health benefit of preventing VTE is considerable. Venous thrombosis is often Elements of a VTE Prevention Strategy. Careful order set design therefore reached Level 3 on the Hierarchy of Reliability and set the stage for further progress and interventions. Content last reviewed February 2016. The improvement team adjusted its approach out of necessity and added more of the key principles of CDS outlined in this chapter after earlier attempts failed to achieve the desired results. It is important to know about VTE because it can happen to anybody at any age and cause serious illness, disability, and in some cases, death. Note also the capture of VTE risk level, the dosing guidance for renal insufficiency, and the mandatory documentation of anticoagulation contraindications in those who defer risk-appropriate anticoagulant prophylaxis. (PDF) This protocol pertains to prevention of VTE in low and high risk pregnant patients adm itted as inpatients. hެW�n�6�}�E��~+��n�$-ֻM#��:Bmː�6����d��,��g�R*x&� Implement the VTE Prevention Protocol, Chapter 6. Purpose Can the protocol be changed so it fits more patients and situations? a. VTE prophylaxis should NOT be held for patients with an elevated baseline INR Questions the team can ask include: The team will also want to plan for measurement. in VT VTE. VTE prophylaxis(or blood clot prevention) consists of injections or tablets of blood thinners (anticoagulants) and/or compression stockings or compression devices. 0 Effective implementation of the VTE prevention protocol addresses the first four failure modes discussed in Chapter 2: With implementation, the improvement team will want to add more granular detail to the general VTE risk assessment models depicted in Chapter 4. Age, body mass index, creatinine clearance, already prescribed antiplatelet or anticoagulant agents, and platelet counts are a few examples of discrete data elements that could be auto-populated. Some examples to consider: Many centers have adapted definitions such as "ambulates independently outside of room twice daily" or "ambulates 50 feet or more independently.". Capturing all data element choices in the ordering process, including the declared DVT risk level and any contraindications to anticoagulant prophylaxis. The risk assessment models this team used had some drawbacks. Order sets with guidance are in place and used, but used incorrectly. It most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. Background: • Pregnant women have increased risk of VTE given venous stasis of lower extremities, Monitoring order set use, and designing an ongoing process to identify patients who have fallen through the cracks, can spur mitigation of lapses in care concurrently. The three measures included in the Improvement Map are process measures for the three key points in hospital VTE prevention: assessment, prophylaxis (aligns with SHM key metric #1) and discharge instructions. Rolling out the protocol is only the beginning. endstream endobj startxref TRW.CLI.SOP.632.2 Venous Thromboembolism (VTE) Prevention SOP Venous Thromboembolism (VTE) Prevention Standard Operating Procedure 1 Purpose and Scope Venous Thromboembolism (VTE) is a significant cause of death in hospital inpatients and treatment of non-fatal symptomatic VTE … Standardize –Create a VTE Prevention Protocol Embed protocol guidance into order sets, hard stops for use on admission, transfer, and post op –Provide seamless CDS Go beyond core measures / SCIP - better measures Active day-to-day surveillance, in addition to monthly / quarterly It is far more effective to provide less guidance in the time and space where prophylaxis is ordered. However, without comprehensive … Importantly, the addition of risk score points is performed behind the scenes, with options appropriate for the point total displayed as the default prophylaxis choice. In other CPOE systems, the risk assessment data entered on the first screen trigger the appearance of a second screen that contains only the choices appropriate for that level of risk in an algorithmic fashion. In general, an intervention that interrupts workflow will be rejected. Mandatory selection of high, moderate, or low risk was mandated on admission and transfer. 316 0 obj <>stream This document provides guidance to perioperative team members for developing and implementing a protocol for prevention of venous thromboembolism (VTE), including prevention of deep vein thrombosis (DVT) by mechanical and pharmacologic prophylaxis and prevention of pulmonary embolism (PE) as a complication of DVT. �I�Lz�TLGzK�E�[��0cR����&�e�DqPU ϔ��1�Ѐe��&��hH4LDbHId�r�Ddr-Ȩ�hГ��ʓ(R��Аh`;ZB�aL�����,x�7��'����߿^�o/Ӝw�uQN��ᱮ��r�M���cq\VC^��)��r�?����.t�@��5��=��q���;���:2�xϻu�ԯϪ|R3ͻO5-y]L�>9���~[V�lԸr�\��Y��~�d�љ�I7Z�;��A�Ȝ��,�~ɋ�cͼ�. Order sets with guidance are in place, but the order set is bypassed or not used. A small number of people will also need prevention continued after they are discharged from hospital, e.g. In some computerized physician order entry (CPOE) systems, after a VTE risk level is determined, the appropriate prophylaxis options for the chosen level of VTE risk emerge from their nested position under the risk designation. Banner Good Samaritan used measure-vention, multiple methods to engage nurses and physicians, and audits to monitor and improve adherence to IPCDs. They illustrate the central importance of implementation and clinical decision support techniques across disparate hospital settings and VTE risk assessment models. This can save effort and time down the road. Am J … AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Responsibilities for a desired action are. VTE. %PDF-1.5 %���� The end result of this implementation effort was significant reductions in surgical and medical VTE rates. The HSE’s COVID-19 Interim Clinical Guidance - VTE protocol and patient information for acute hospitals is available here. The VTE risk assessment and bleeding risk assessment are ideally performed quickly and concurrently when the choices for that combination of risks are presented directly to the provider, without interruption by intervals in time or space. In addition, a full suite of educational and faculty engagement techniques were used. This has several implications for design and implementation of VTE prevention order sets. h�b```a``��b�@(� enous thromboembolism (VTE) prevention is addressed daily in nearly every hospital in the world. The major outcome considered for this guideline is the prevention of VTE with the therapy that is most appropriate based on individual patient VTE and bleeding risk. Opting out of anticoagulant prophylaxis for moderate- or high-risk patients led to capture of anticoagulant contraindications and default choices for mechanical prophylaxis. Can it be integrated into other heavily used order sets? In these cases, the ordering provider is not asked to remember the risk designation from a previous screen, add up points, and so forth. The good news is that VTE can be prevented and treated if discovered early. Finally, redesign of the process and order sets should continue to improve the system.3,4, Three Examples of Effective Implementation and Clinical Decision Support. A balance between the need to provide protocol guidance and the need for efficiency and ease-of-use by the clinician must be maintained. 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