DVT Prevention and Anticoagulant Management

•Aims•Measures•Literature•Data

DVT Prevention and Anticoagulant Management

• Aims (What are we trying to accomplish?)– Reduce the incidence of DVT and PE in hospitalized

patients by 50% in one year.

– Reduce readmissions within 31 days for DVT and PE by 50% in one year.

– Reduce patient harm associated with the use of anticoagulant therapy by 50% in one year.

DVT Prevention and Anticoagulant Management

• Measures (How will we know that a change is an improvement?)

– Hospital Acquired DVT per 1000 Discharges

– Hospital Acquired PE per 1000 Discharges

– Readmissions within 31 Days with DVT per 1000 Discharges

– Readmissions within 31 Days with PE per 1000 Discharges

– Patient harm associated with anticoagulant therapy as measured by the IHI Adverse Drug Event Trigger Tool

DVT Prevention

• Clinical Goals– Adult patients (18 & older) are assessed for

VTE risk within 24 hours of admission– Appropriate pharmacological and/or

mechanical prophylaxis begins within 24 hrs of admission.

Venous Thromboembolism Prophylaxis, June 2007, ICSI

DVT Prevention

• Clinical Goals– All patients receive education regarding VTE

signs & symptoms, preventive methods– All patients begin early and frequent

ambulation

Venous Thromboembolism Prophylaxis, June 2007, ICSI

DVT Prevention

• Clinical Goals– All adult medical/surgical patients with

moderate-high-very high VTE risks receive anticoagulation prophylaxis unless contraindicated.

– Reduce the risk of complications from pharmacologic prophylaxis.

Venous Thromboembolism Prophylaxis, June 2007, ICSI

DVT Prevention

• Clinical Goals– Appropriate pharmacological and/or

mechanical prophylaxis begins within 24 hrs of admission.

– Mechanical prophylaxis is used when pharmacologic prophylaxis is contraindicated.

– Appropriate precautions for patients receiving spinal or epidural anesthesia are implemented.

Venous Thromboembolism Prophylaxis, June 2007, ICSI

National Patient Safety Goal 3E: Anticoagulation

• Reduce the likelihood of patient harm with the use of anticoagulation (AC) therapy.

• Applies to multiple inpatient and outpatient settings

• Rationale: Anticoagulation therapy is a high risk treatment

NPSG 3E Implementation Expectations:

• Implement a defined AC program

• Use ONLY oral UD products/pre-mixed IV’s

• Warfarin is dispensed for each patient with established monitoring

• Use approved protocols for the initiation & maintenance of AC therapy

NPSG 3E Implementation Expectations:

• Warfarin – baseline/current INR

• Dietary services notification of pt’s receiving warfarin

• Heparin IV by a programmable IV pump

• Policy addresses baseline & ongoing lab tests for Heparin/LMWH

NPSG 3E Implementation Expectations:

• Education for Anticoagulation therapy: prescribers, staff, patients and families.

• Pt./family education covers specific areas

• Evaluation of Anticoagulation safety practices.

Baseline Measures• Hospital Acquired DVT per 1000 Discharges

• Hospital Acquired PE per 1000 Discharges

• Readmissions with DVT per 1000 Discharges

• Readmissions with PE per 1000 Discharges

Time Frame: FY 07