Venous Thromboembolism

By: Anthony Paguyo, Todd Shumway, Reina Fujiwara, Virginia Small, Chris Hillman, Christine Rombawa

What is VTE?

PDCA (IHI) Quality Improvement ModelPlan: In addition to the existing prophylaxis techniques, we would recommend utilizing a risk assessment tool, and a clinical protocol that includes duplex screening exams for high risk patients. It would benefit the patient by identifying DVTs earlier and decrease the progression to PE in a cost effective way.

Do: Upon admission, complete risk assessment card to guide the prophylaxis treatment and clinical protocol that includes the use of serial duplex exams for high risk patients. Use flowcharts and run charts to collect data, interpret results, and evaluate effectiveness of change and compare with previous surveillance period. Track adherence to mechanical prophylaxis, anticoagulants, ambulation, SCDs, serial duplex exams, and patient education. Make refinements to the plan as needed by providing in-services for providers and clinical nursing staff, along with updating staff on the results of audits, and seeking input regarding barriers or/and improvements to workflow process.

Check: Performance tracking is an important component to a Quality Improvement Program. Various tools, such as flowcharts and run charts, may be used to collect data, interpret results, and implement improvement actions and evaluate effectiveness.Tracking adherence to mechanical prophylaxis, anticoagulants, ambulation, and patient education is also important. Performing daily visual checks by the Charge Nurse and conducting audits weekly of the EHR will aid in the effectiveness and evaluation of the VTE prophylaxis quality improvement program. Providing in-services for providers and clinical nursing staff will also be beneficial, along with updating staff on the results of audits, and seeking input regarding barriers or/and improvements to workflow process.

Act: Implement the changes in a real work setting

SCDs

What is it?

Pros vs Cons

Data on effectiveness of treatment

Medications

INITIAL THERAPY

Unfractionated Heparin

Low Molecular Weight Heparin

Factor Xa Inhibitors

Direct Thrombin Inhibitors

LONG TERM

Vitamin K Antagonists (Warfarin) (LT)

Aspirin

Clopidogrel

Duplex ExamA duplex ultrasound combines traditional ultrasound with Doppler ultrasound.

Traditional ultrasound uses sound waves that bounce off blood vessels to create pictures.Doppler ultrasound records sound waves reflecting off moving objects, such as blood, to measure their

speed and other aspects of how they flow.A transducer sends out the sound waves. A computer measures how the sound waves reflect back, and

changes the sound waves into pictures. The Doppler creates a "swishing" sound, which is the sound of your blood moving through the arteries and veins.

CASE STUDY

60 year old man, POD 1 for total hip replacement. He has history of smoking, and he is overweight.

As his nurse, what can we do to prevent VTE from occurring?

Patient EducationAssess the patient

Early ambulation

Ankle pumps

Encourage adequate hydration.

SCD

Signs and symptoms

Risks for non-compliance and benefits of prophylaxis treatment

Risk for bleeding

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