Organizational Initiative

Transcription

1 Organizational Initiative Prevention and Treatment of Venous Thromboembolism (VTE) Nursing s Role Donna Grochow MSN, RN May

2 Agenda Organizational Initiative: Why Now? Review of current performance Changes: QUEST changes for VTE Risk Assessment & Prevention Education Plan Key Points Manager s Role 2

3 Organizational Initiative-Why Now? Approximately one million cases of VTE occur in the U.S. each year 2/3 of these result from hospitalization 300,000 of these patients DIE Pulmonary embolism is the most common preventable cause of hospital death in the United States 3

4 Organizational Initiative-Why Now? Regulatory Requirement: 2009 National Patient Safety Goal Quality Measure: AACN VTE Prevention Practice Alert Surgical Care Improvement Project (SCIP) Measure Leapfrog Indicator Core Measures 1-6 AHRQ Patient Safety Indicator 12-Postop PEs & DVTs Monetary Issue: Delivery System Reform Incentive Payment (DSRIP) 4

5 Organizational Initiative-Why Now? Our data demonstrates that there is room for improvement: Above the Target 6 of 9 Quarters 5

6 Organizational Initiative-Why Now? Our data demonstrates that there is room for improvement: VTE Prophylaxis ordered anytime from admission to 24 hours after surgery 6

7 Organizational Initiative-Why Now? Our data demonstrates that there is room for improvement: <100% Patients received VTE Prophylaxis within 24 hours prior to surgery to 24 hours after surgery 7

8 Organizational Initiative-Why Now? Our data demonstrates that there is room for improvement: VTE-1:Med-Surg: Prophylaxis within 24 hours of admission VTE-2:ICU: Prophylaxis within 24 hours of admission VTE-3: Anticoagulation Overlap Therapy administered for 5 days with INR>2 VTE-4: Platelet monitoring for patients on unfractionated heparin by protocol VTE-5: VTE discharge instructions for patients on Warfarin VTE-6: Incidence of potentially preventable VTE that did not receive prophylaxis 8

9 A recent audit of 80 UC Irvine patients that had orders for SCD s showed only 30% had the SCD s on and functioning 9

10 That Means: 70% did not receive the ordered treatment for VTE prevention and were put at risk! 10

11 Plan for Improvement: What s New? Mandatory MD VTE Assessment in Quest implemented on May 7 th Three tiered VTE risk and treatment guidelines: High risk - Pharmocologic prophylaxis and mechanical prophylaxis Moderate risk Pharmocologic prophylaxis or mechanical prophylaxis if drugs contraindicated Low risk Early and aggressive ambulation or mechanical prophylaxis Discharge Instructions: Patient education for anticoagulation medications automatically print with Discharge Instructions 11

12 What s New: MeasureVention Reports Nursing Units Discussion: How can this be utilized? 12

13 Education Plan Mandatory CBT RN Staff: (CNI, CNII, CNIII, CNIV, CNS, CNE, Nurse Manager, CNIII Sup?) Prevention and Treatment of Venous Thromboembolism (VTE) Review of AACN VTE Practice Alert Anticoagulation Therapy Safety Mandatory CBT for Nursing Assistants Education Update of Key Points 13

14 Week of June 4th: CBT assigned to staff 3 weeks to complete Timeline 14

15 RN Responsibility: Key Points Understand risk factors Understand treatment guidelines for low, moderate and high risk patients Implement prophylaxis as ordered Review plan daily and discuss with MD as needed Encourage patient compliance with SCD s Document all interventions If patient refuses SCDs-document patient refusal of SCDs on flow sheet and document notification of MD 15

16 RN Responsibility: Key Points Patient Education: During hospital stay Discharge: Ensure patient receives discharge education regarding medications, diet, activity, etc. Required documentation for patient s on Warfarin:» Dietary» Follow-up Monitoring» Potential Adverse drug reactions and interactions Document all teaching Only print Discharge Instructions once Pharmacy Review of Home Medication List has been completed Ensure post-discharge follow-up appointments are scheduled 16

17 Patient Education The following new educational handouts are available: Preventing and Treating Blood Clots with Warfarin Preventing and Treating Blood Clots with Heparin Preventing and Treating Blood Clots with Fondaparinux Preventing and Treating Blood Clots with Enoxaparin (Lovenox) or Dalteparin (Fragmin) Preventing and Treating Blood Clots with Enoxaparin (Lovenox) plus Warfarin (or Dalteparin plus Wafarin) 17

18 Manager s Role Track compliance with mandatory CBT education 18

19 Questions? 19