Presentation on theme: "VTE Prophylaxis Alert to providers and nursing Go live June 24, 2014."— Presentation transcript:
VTE Prophylaxis Alert to providers and nursing Go live June 24, 2014
VTE Prophylaxis – why do it? The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that “the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism” (Shojania, 2001).
VTE Prophylaxis – why do it? Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008). In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the "number one patient safety practice" for hospitalized patients (Shojania, 2001). Updated “safe practices” published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006). (Taken from eCQMs for EH’s updated April 2014)
VTE Prophylaxis in the EMR - current state On admission, the VTE prophylaxis needs to be addressed. Either an order for pharmacologic prophylaxis, an order for mechanical prophylaxis, or documentation of a contraindication to the VTE Prophylaxis. This order should be based on the patient’s risk for developing a VTE. Orders can be placed via the orders tab or through the Order link on the widget. The admission PowerPlans have VTE prophylaxis orders embedded within them for easy ordering. Contraindication must be charted from the link on the widget.
VTE Prophylaxis Alert - new If the patient has been admitted for 8 hours, and orders for VTE Prophylaxis have not been placed nor documentation of the contraindication, the alert will fire to the provider when signing an order notifying them that an order needs to be placed or to document the contraindication. Orders for VTE prophylaxis may be placed inside the alert window.
VTE Prophylaxis Alert The ‘document’ link in the alert will open the VTE Prophylaxis contraindication PowerForm.
VTE Prophylaxis Alert The alert will continue to fire for 48 hours after admission or until the orders have been placed or the documentation of the contraindication is complete. Additional VTE risk factors will be displayed if documented in the record. Those being diagnosis or problem of cancer or previous VTE (DVT/PE), BMI greater than 30, smoker, age 60 or greater and home medication of estrogen. If the patient has a higher risk factor (s), pharmacological agents should be considered.
VTE Prophylaxis Alert – surgical patients with neuraxial anesthesia Patients that have surgery with neuraxial anesthesia are more prone to bleeding, therefore, the alert will not fire for 24 hours after anesthesia end time. Neuraxial anesthesia is documented in the perioperative record. It will be documented as “epidural”, “spinal”, “caudal”, “general/epidural”, “general/intrathecal” and “intrathecal”.
VTE Prophylaxis Nurse Alert If there is an active order for Sequential Compression Device (SCD), and nursing has not completed the documentation in Iview, the nurse will receive an alert when opening the patient record. Nursing may click on the document link and a PowerForm will open to document the SCD’s. This information will flow to Iview. The alert will begin after the patient has been admitted for 10 hours and will continue until documentation has occurred or for 48 hours after admission.
References Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008; 133:381S-453S Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371:387-394. Shojania KG, Duncan BW, McDonald DM, et al. (Eds.). (2001). Making healthcare safer; A critical analysis of patient safety practices (Evidence Report/Technology Assessment No. 43). Prepared by the University of California at San Francisco-Stanford Evidenced-based Practice Center under Contract no. 290-97-0013 (AHRQ Publication NO.01-E058). Rockville, MD:Agency for Healthcare Research and Quality. National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Policy, Preferred Practices, and Initial Performance Measures. A Consensus Report. Washington, DC. NQF; 2006