1.  Deep Vein Thrombosis Josh Vrona, Hunter Dolan, Erin McCann

2. Signs and Symptoms of a DVT  50% of patients do not have symptoms  Swelling in leg; red, discolored, or white skin; tachycardia, fever, warm skin over affected area; aching, tiredness, tenderness, and leg pain.

3. Defining the Problem  DVTs are caused by damage to the inner lining in the vein  Examples: surgery, serious injuries, inflammatory responses  Blood Flow becomes slower and sluggish due to a decrease in motion, which causes the blood to be thicker than normal and therefore, more likely to clot.  Contributing factors: genetics, prolonged bed rest, injury, surgery, pregnancy, birth control pills, HRT, obesity, smoking, cancer, heart failure, age (>60), inflammatory bowel disease

4. Defining the Problem  Complications: Pulmonary Embolism, Postphlebitic syndrome  Scope of problem: According to the CDC it is thought that as many as 900,000 people could be affected each year.  60-100,000 Americans die of DVT/PE  Among people who have had a DVT, 50% will have complications  Surveillance studies have found that the absolute risk of DVT is 10-20% among general medical patients, and up to 40-60% in patients having hip surgery, knee surgery, or major trauma.

5. Implications for Patient  At an increase risk for developing another blood clot  Need to be aware of new leg pain, swelling, or redness  Increased risk for bleeding d/t anticoagulant use  Need to wear an alert bracelet that says they are on anticoagulants  Aim to reduce their risk of bleeding

6. Implications for Institution  “In 2001, the Agency for healthcare research and quality began a campaign to combat med error in order to improve patient safety. The use of appropriate VTE prophylaxis was included in this.”  “The National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism is a policy created by the National Quality Forum that states “Every healthcare organization shall have a written policy appropriate for its scope that is evidenced based and that drives continuous quality improvement related to venous thromboembolism risk assessment, prophylaxis, diagnosis and treatment.”

7. Implications for Institution  The mean hospital cost per readmission for recurrent DVT was $11,862  Medicare will no longer pay hospitals for additional costs considered to be hospital acquired conditions  Private health care plans and other health care purchasers have their own nonpayment policies, but most are the same as Medicare.

8. Implications for Healthcare Resources  Very expensive to care for these patients  DVT patients average $16,000 more in medical costs than patients without a DVT.  If a DVT is the primary diagnosis the average cost is $10,800

9. Recommendations  For patient care: anticoagulants for at least 3 months, thrombolytic therapy, vena cava filter  Prevention/prophylaxis: Anticoagulant medications (heparin, lovenox, coumadin), moving lower legs, bending knees frequently, getting up to walk as soon as the patient is able to, pneumatic compression device, elastic stockings

10. Nursing Role  Assessment: look for signs and symptoms of a DVT (leg pain, ankle engorgement, swelling, differences in leg circumference, temperature changes, feeling of heaviness in affected limb, Homan’s sign)  Planning: Take prophylactic measures, get patient up and walking as soon as possible

11. Nursing Role  Interventions: Prophylactic measures, frequent assessment for signs of a DVT, monitor anticoagulant therapy, monitor for and manage potential complications (bleeding, PE), work with PT to get patient up and moving, provide rest and comfort (if they have a DVT-bed rest, analgesics, warm compress, elevation of extremity)  Evaluation: Pt will not develop a DVT, Pt will not develop a PE, absence of SOB, monitor patients PT and INR

12. Spectrum’s Initiatives

13. Education Materials  Teach them about their medication regimen  Example: how to take it, complications, when to see a doctor, blood tests needed  Teach them how to prevent DVTs  Walking/moving whenever possible, wearing PCDs, continuing medications prescribed  Teach them risk factors and signs that indicate a DVT

14. Conclusion  DVTs are a preventable complication  They are an extremely expensive medical cost so nurses should take every precaution possible to prevent them  The nurses responsibilities include assessing the patient for signs of a DVT, monitoring therapy initiated to prevent or treat a DVT, and keep patients as mobile as possible

15. Sources  http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/causes http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/causes  http://www.mayoclinic.org/diseases-conditions/deep-vein- thrombosis/basics/complications/con-20031922 http://www.mayoclinic.org/diseases-conditions/deep-vein- thrombosis/basics/complications/con-20031922  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379443/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379443/  http://surgery.med.miami.edu/vascular-and-endovascular/patient-care- services/dvt http://surgery.med.miami.edu/vascular-and-endovascular/patient-care- services/dvt  http://nursingfile.com/nursing-care-plan/nursing- interventions/nursing-management-of-deep-vein-thrombosis.htmlhttp://nursingfile.com/nursing-care-plan/nursing- interventions/nursing-management-of-deep-vein-thrombosis.html

16. Sources  http://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/basics/risk- factors/con-20031922 http://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/basics/risk- factors/con-20031922  http://www.uptodate.com/contents/deep-vein-thrombosis-dvt-beyond-the-basics http://www.uptodate.com/contents/deep-vein-thrombosis-dvt-beyond-the-basics  http://www.cmsa.org/portals/0/pdf/CMAG_DVT.pdf http://www.cmsa.org/portals/0/pdf/CMAG_DVT.pdf  http://www.nbch.org/nbch/files/ccLibraryFiles/Filename/000000001630/HAC%20P ayment%20Policy%20Toolkit%20(final%20version)%20081109.pdf http://www.nbch.org/nbch/files/ccLibraryFiles/Filename/000000001630/HAC%20P ayment%20Policy%20Toolkit%20(final%20version)%20081109.pdf  https://ci4.googleusercontent.com/proxy/ETfN6w6_3qeypfsWViq3ZBhY- 5q3nv7yWtood7cmOQz6vGNiI7CIU6a6e5JVJ-NnMiQ2zOjATODaIuoTHwdvK7cWrGuOdnzLm62XrDSh=s0-d-e1- ft#http://www.spectrumhealth.org/images/Quality/SCIP-15.jpg https://ci4.googleusercontent.com/proxy/ETfN6w6_3qeypfsWViq3ZBhY- 5q3nv7yWtood7cmOQz6vGNiI7CIU6a6e5JVJ-NnMiQ2zOjATODaIuoTHwdvK7cWrGuOdnzLm62XrDSh=s0-d-e1- ft#http://www.spectrumhealth.org/images/Quality/SCIP-15.jpg