After reading this learning module, the nurse should be able to:

Transcription

1 After reading this learning module, the nurse should be able to: Identify the VTE dashboard and understand how to initiate it Identify the requirements of the VTE Core Measure and the nurse s responsibilities for each

2 VTE (A DVT or PE) is the most common PREVENTABLE serious complication in the hospital and the second most common cause of increase length of stay. 10% of hospital deaths are attributed to PE, PE is the most preventable cause death. About 350,000 to 600,000 cases of DVT and pulmonary embolism (PE) are reported annually. 200,000 deaths occur from DVT/PE which is more than AIDS and breast cancer combined.

3 VTE is the newest Core Measure Requires VTE prophylaxis to be addressed on ALL in-patients. Pharmacological prophylaxis, mechanical prophylaxis, or a contraindication to prophylaxis must be documented on the day of admission or the day after admission.

4 Apr 2012 May 2012 Jun 2012 Jul 2012 Aug 2012 Sep 2012 Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Core VTE-1 - Venous Thromboembolism Prophylaxis Core VTE-2 - ICU Venous Thromboembolism Prophylaxis Core VTE-3 - VTE Patients With Anticoag Overlap Therapy Core VTE-4 - VTE Pts Receiving UFH with Dosage/Platelet Monitoring Core VTE-5 - VTE Warfarin Therapy Discharge Instructions Core VTE-6 - Hospital Acquired Potentially-Preventable VTE Core VTE ALL All-or-None Bundle Much room for improvement Goal is 100%

5 Current best practice - nursing should perform a VTE risk assessment. The VTE risk assessment is required for all adult inpatients.

6 Completion of VTE risk assessment is required for: All adult inpatients at time of admission All patients transferred into an ICU All patients who under go a procedure requiring general anesthesia

7 Admitting nurse should check ALL fields that apply to patient The score will automatically populate to the box

8 Nursing Responsibility Locate the suggested plan under ORDERS and initiate the plan. If no suggested plan exists, order one and initiate it

9 The goal of the CDI nurses is to identify patients who have a VTE and establish if it is present on admission and make sure that it is documented appropriately. The CDI nurses use the physician documentation to assist in coding appropriately. Nursing documentation is used to correlate physician findings.

10 1-VTE Prophylaxis 2-ICU VTE 3-VTE Patients with Anticoagulation Overlap Therapy 4-VTE Patients Receiving Unfractionated Heparin with Dosages/Platelet Count Monitoring by Protocol 5-VTE Warfarin Therapy Discharge Instructions 6-Hospital Acquired Potentially Preventable VTE

11 The day of or the day after hospital admission patients must receive VTE Prophylaxis or have a documented reason why no VTE was given Nursing Responsibility: Ensure every patient has prophylaxis ordered and it is initiated. Examples of prophylaxis are heparin, Lovenox, or SCDs. Medications must be ADMINISTERED and SCDs must be documented as being APPLIED. If no prophylaxis is ordered and no reason is documented why there is no prophylaxis, call physician for order.

12 The day of or the day after ICU admission (or transfer) patients must receive VTE prophylaxis or have a documented reason why no VTE was given Nursing Responsibility: That every patient has prophylaxis ordered and it is initiated. Examples of prophylaxis are heparin, Lovenox, or SCDs. Medications must be ADMINISTERED and SCDs must be documented as being APPLIED. If no prophylaxis is ordered and no reason is documented why there is no prophylaxis, call physician for order. Completion required for ALL patient admitted to ICUs and transferred into ICUs.

13 For all patients who are diagnosed with a VTE and receive an overlap of parenteral (IV or Subcu) anticoagulation and warfarin Overlap therapy should be administered for at least 5 days with an INR > or = 2 prior to discontinuation of anticoagulation Patients who receive < 5 days of overlap therapy should be discharged on both medications or have a reason documented for Discontinuation of Parenteral Therapy

14 Patient s with a diagnosed VTE who receive IV UFH therapy must have their therapy dosages AND platelet counts monitored according to the Heparin by Weight Protocol Nursing Responsibility: Ensure that ALL patients with IV UFH (Weight Based Heparin) have the Weight Based Heparin Protocol ordered. Ensure that the DAILY CBC that is part of this protocol is NOT discontinued if additional CBCs are ordered.

15 Patients with a diagnosed VTE discharged to home, with home care, court/law enforcement or home hospice must be given written instructions containing 4 key elements Compliance Dietary documentation Information about plans to monitor warfarin after discharge Information on adverse drug/food reactions Nursing Responsibility: Ensure that every patient going home on warfarin (Coumadin) receives the Warfarin Education Discharge Instructions. These instructions include all four components required for the VTE Core Measure and are found on the intranet (see following slides). This education should be completed during the entire patient stay, not just at discharge.

16 1. Access Aultman Intranet 2. Click on Tools 3. Click on Policy and Procedures 4. Type Patient Education: Treatment with Warfarin in the Search for box 5. Click on this and print

17 1. Compliance must address: The importance of taking warfarin as instructed AND The importance of monitoring warfarin with scheduled PT/INR blood draws 2. Dietary Documentation must instruct the patient all of the following: A consistent amount" of foods with Vitamin K rather than avoidance should be advised Avoid major changes in dietary habits, or notify health professional before changing habits

18 3. Follow-up must include information about plans to monitor warfarin after discharge 4. Information on adverse drug/food reactions must contain the following: Diet and medications can affect the PT/INR level Do not take or D/C any medications or over-thecounter medications without advice from a physician/pharmacist Warfarin increases the risk of bleeding

19 Nursing documentation for the Warfarin Discharge Instructions must be done on the Warfarin (Coumadin) powerform. All four boxes must be checked complete to meet the requirements. This form fires ONE time only when the med is ordered.

20 Contact: Tieryn Trissel ext