Patient Safety Initiatives for Blood Clot Prevention
By: Susannah Noel
Protecting patients from blood clots
With the global coronavirus pandemic causing heightened focus on patient care, we’re highlighting patient safety in hospitals. A top way to avoid unnecessary complications and deaths is to work on preventing blood clots — or venous thromboembolisms (VTE). Every year, 350,000 to 600,000 people are affected by VTE, which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE).
Over half of VTE cases are associated with a recent hospitalization or surgery (HA-VTE), and reports show that as much as 70 percent of those could be prevented.
Patient safety initiatives around VTE are focused on four areas: assessment, prophylaxis, education, and process measures.
Assessment
Each patient admitted to in-patient care should be assessed for their risk of developing HA-VTE. All men and women, regardless of age, race, or ethnicity, are at risk for blood clots, but certain populations are at higher risk. Those at higher risk include patients with cancer, patients undergoing surgery, those who have traveled long distances recently, and women who are pregnant or taking estrogen.
In 2015, Hutchinson Regional Medical Center in Hutchinson, Kansas, implemented a risk assessment tool for its nursing admissions process, with surgical and cancer patients automatically receiving high scores. The tool was built into its electronic health record (EHR) system, and the risk score was transmitted to the main vital signs page. This tool helped the facility reach an 11-month streak of no patient harm from VTE.
Prophylaxis
Prevention of blood clots can be achieved through both mechanical and pharmacological interventions, as well as daily ambulation.
Mechanical methods
Compression devices are a proven method for preventing blood clots. There are a range of compression devices available, including graduated compression stockings, intermittent pneumatic compression devices (IPC), and anti-embolic pumps.
Pharmacological agents
Anticoagulants, such as heparin and warfarin, are used to prevent blood clots. However, because there are risks associated with anticoagulation, the Physician-Patient Alliance for Health & Safety recommends using IPC therapy in conjunction with pharmacological approaches.
Education
A major feature of patient safety efforts is education of patients and clinicians. Patients need to be informed of VTE signs and symptoms during their stay, as well as after discharge — about 60 percent of VTE cases occur after patients leave the hospital. Physicians, nurses, administrators, and pharmacists should be apprised of HA-VTE risks and taught best practices for prevention and treatment.
Educational processes were integral to the success of an anticoagulation stewardship program at the University of Wisconsin Health in Madison.
- Pharmacists received training through in-service and competency testing, including live presentations and computer-based training.
- Nursing education centered around prophylaxis and stressed the need for nurses to communicate with the pharmacist and physician in the event the patient refused prevention protocols.
- Physicians were trained in VTE risk through order set group discussions and newsletters.
Process improvement
Improving and supporting HA-VTE monitoring and prevention are critical for the successful reduction of VTE incidence. Updates to order sets, or orders for a specific diagnosis or period of time, offer low-friction methods to alert clinicians to the junctures where VTE should be assessed and treated. Technological solutions are key — EHR risk assessment tools, dashboards and scorecards, and compliance checks are some of the ways technology can be leveraged to assist in VTE reduction.
For example, at Northwestern Memorial Hospital in Chicago, compliance failures were tracked in real time, with data on weak links in the process. Feedback was rapidly transmitted to nursing managers so that failures could be identified and rectified as soon as possible.
A holistic approach
For patient safety efforts to take root and flourish, a web of connected methods is needed. The VTE Safety Toolkit aims to assist in delivering such a connected approach and increase the implementation of safe practice interventions for people diagnosed with or at risk for VTE.
Created in partnership by the University of Washington Medical Center, UW School of Nursing, and the Center for Health Sciences Interprofessional Education and Research, the Toolkit contains evidence-based tools for the prevention, diagnosis, and treatment of VTE. It offers prophylaxis strategies, treatment methods, and quality improvement tools, as well as an integrated clinical database, and computerized logbooks.
This type of holistic approach has shown promise in turning the tide of HA-VTE morbidity and mortality. In 2015, the U.S. Centers for Disease Control and Prevention (CDC) recognized eight hospitals and healthcare systems as Hospital-Associated Venous Thromboembolism Prevention Champions. All eight facilities used a multi-pronged approach to combat HA-VTE, including:
- Engaging teams of clinicians and staff to support efforts
- Increasing education and awareness of HA-VTE
- Making use of technology
- Integrating feedback on the efficacy of efforts
At a time when patient safety is at the forefront, clinicians can use these lessons to evaluate their institutions’ responses and protocols and take steps to mitigate the risk of HA-VTE.
Learn more about VTE prevention and protocols at cardinalhealth.com/knowvte
About the author:
Susannah Noel is a Cardinal Health Essential Insights contributor, healthcare writer