Venous Thromboembolism Prophylaxis. Robert A. Thompson, MD, MBA Karen Bales, RN, BSN

Transcription

1 Venous Thromboembolism Prophylaxis Robert A. Thompson, MD, MBA Karen Bales, RN, BSN

2 This is a complicated topic!

3 Agenda Rob Thompson Overview Compelling case Karen Bales Protocols OFI process Support Rob Thompson Final comments and questions

4 Definition Definitions of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Venous Thromboembolism (VTE): DVT refers to the formation of one or more blood clots in one of the body s large veins, most commonly in the lower limbs (e.g., lower leg or calf). The most serious complication that can arise from DVT is a PE, which occurs when a portion of the blood clot breaks loose and travels in the bloodstream first to the heart and then to the lungs, where it can partially or completely block a pulmonary artery or one of its branches. DVT and PE are collectively referred to as VTE.

5 The right thing to do More than 2 million Americans suffer from VTE. VTE is the #1 cause of preventable death among hospitalized patients! Over half develop VTE in the hospital or in the 30 days posthospitalization. One in ten of those who develop a VTE go on to die from PE with a 90 day mortality rate of 17.5%! 200,000 patient deaths represent more annual deaths than those from breast cancer, AIDS, and traffic accidents combined! Fewer than 5 percent of medical patients could be considered at low risk for VTE.

6 Post-thrombotic Syndrome Post-thrombotic syndrome, a complication that occurs in 40% 80% of patients who develop blood clots, may result in permanent disability. Chronic stasis Ulcers Post-pulmonary Embolism Pulmonary hypertension Right sided heart failure Adverse drug events

7 We can t afford not to! Cost-effectiveness of VTE prophylaxis has been repeatedly demonstrated. Pharmacologic prophylaxis reduces the incidence of VTE by 50 percent to 65 percent! AHRQ estimates average avoidable savings at $10,000 per DVT and $20,000 per PE. The Centers for Medicare & Medicaid Services (CMS) has included VTE related to total knee replacement and hip replacement (when not present on admission) among the hospital-acquired conditions for which it will no longer pay, effective October 1, CMS Core Measures and Meaningful Use

8 The Joys of Meaningful Use

9 With VTE prevention, there is a disconnect between evidence and execution. One large epidemiological study found that 71% of patients diagnosed with VTE had received no prophylaxis within the past 30 days. Prophylaxis Every patient admitted to the hospital should be considered to be at risk for VTE, and preventive measures should be considered the standard of care!

10 The Road to VTE

11 Best Practice Advisories will display within the appropriate Navigator. As a practitioner accesses the patient chart within Epic, they will have the opportunity to utilize a Navigation panel to assist them with their documentation workflow. In this illustration, there are multiple Navigators available: Admission, Transfer, Discharge

12 When a VTE prophylaxis order needs to be placed, leaving the appropriate check box selected will take the physician directly to the appropriate order set to be completed and submitted.

13 The Best Practice Advisory allows the practitioner to document a reason for not administering VTE prophylaxis or the option to choose a direct link to an Order Set for the appropriate order.

14 Sample Order Set

15 Closing The Gap.. OFI

16 CONTROLLED UNLESS PRINTED Opportunities for Improvement (OFI) Overview 400-PI PI-0005 Staff Query Databases for Non- Conformities Staff Identify Non-Conformities Staff Report Non-Conformities to Coordinator Coordinator Reviews Non- Conformities Coordinator Selects Appropriate Action Notify Chain of Command Fix Where Can Deliver Just-in-time Education Staff Document Non-Conformities in PATS OFI Database PATS Database Staff Query OFI Database PI-I (13Dec2012) Staff Generate OFI Reports Staff Disseminate Reports to VPs and CCTs VPs and CCT Develop Appropriate Action Plans End of Process Weekly, Monthly, & Quarterly OFI Reports Initiate PI Projects Initiate Further Data Analysis Develop Education

17 Opportunity for Improvement OFI Database

18 Karen Bales, RN BSN Clinical Intelligence Coordinator

19 Now a medical error! The Institute of Medicine has classified the failure to provide appropriate screening and preventive treatment [for DVT and PE] to hospitalized, at risk patients as a medical error, and the Agency for Healthcare Research and Quality has ranked the provision of such preventive treatment as one of the most important things that can be done to improve patient safety. Proven, effective measures are available to prevent and treat DVT and PE in high-risk individuals. Yet today the majority of individuals who could benefit from such proven services do not receive them. Michael O. Leavitt Secretary of Health & Human Services, United States Public Health Office in The Surgeon s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism, 2008

20 Thank you! References: 1. Implementation Guide to Prevention of Venous Thromboembolism (VTE). December Cynosure Health. 2. VTE Guide for Executive Leadership Implementing a VTE Prophylaxis Process for Hospitalized Patient Health Services Advisory Group.