Venous thromboembolisms (VTE), or blood clots in the veins, affect as many as 900,000 Americans in the U.S. each year, about 50 percent of them are healthcare-associated, and as many as 70 percent of cases are preventable, according to the CDC.
However, VTE in healthcare settings can be prevented using several strategies, explained Tania Hoyer, RN, MSN(c), critical care clinical educator and co-chair of the pulmonary embolism response team (PERT) task force at Doylestown (Pa.) Health.
Here, Ms. Hoyer shares how to create an effective VTE prevention committee, foster prevention champions, overcome adherence challenges and find resources available to drive clinician engagement and decision-making.
Editor's note: Responses were edited for length and clarity.
Question: How do you create an effective venous thromboembolism (VTE) prevention committee? What mechanisms make that team effective?
Tania Hoyer: One way to form a best-in-class committee is to involve people who are really engaged in the issue. For many hospitals, it's a common requirement for nurses to be active in a committee, so it's not just getting people who have to be there, but who also are engaged and want to be there. At Doylestown Health, our VTE prevention committee is multidisciplinary. Our team includes nursing informatics, registered nurses, nurse managers, other nurse educators, pharmacy team members, the quality improvement team, and physician champions involved in the committee.In terms of finding the mechanisms to allow us to be effective, one of the important things is to have consistency. During the COVID-19 pandemic it has been a bit more challenging, as it can be more difficult to get people to meet on a regular basis. But even if it's only for a few minutes, meeting on a regular basis really helps ensure effectiveness because it keeps momentum going. So whenever the VTE prophylaxis committee could, we kept on meeting even if there was very little to discuss. We did this so that when we had more time, when the COVID-19 numbers started drifting down a bit, we could jump back in.
Q: Where can you find evidence-based resources to guide decision-making for the committee?
TH: We found up-to-date evidence-based resources in a number of places, including the nursing literature, medical literature and various guidelines. There are many guidelines that give us ideas of what best practice initiatives should be. However, as I was exploring different ways to reinvigorate the staff to look at VTE prophylaxis, I went to the Cardinal Health website and found a lot of valuable information about those guidelines. There are links included for all of the information, links to the guidelines and links to articles in the literature. This provided some different ideas to guide decision-making, promote VTE prophylaxis and engage people a little bit more.
Q: How do you empower nurse educators, specialists, or other clinical leaders to be VTE prevention champions?
TH: Most importantly, give them the information and data they need. The first step is to stratify the problem. This would help answer questions like: How does VTE affect your organization? How many patients does it affect? What effects does it have on patients while in the hospital and long term? That's why, for us, it was really important to team up with our quality improvement specialists and data analysts.Additionally, I'd say review the guidelines for VTE prevention expectations and what prevention measures are currently in place at your facility. When reviewing information, especially to front-line providers, it is important to give it to them in short, meaningful bursts, because there's always going to be competing priorities for time. So making it easy, fast, and meaningful are probably the best ways to empower nurses.
Q: How do you overcome adherence challenges related to medical VTE prophylaxis?
TH: I would say get the data. I was very taken aback when I was doing research on VTE prevention for a class. I was surprised at how frequently the orders for VTE prevention are not adhered to. One way to increase adherence is to educate nurses and patients. One thing I found on the Cardinal Health website involved escalation. This is a technique to use when a patient refuses to wear sequential compression devices or inconsistently wears them. You escalate education and don't give up on that patient. Give them more information. Educate the patient and maybe even have another person, like a nurse manager, nurse educator or the physician, talk to them. Notification of the physician when medical devices aren't being adhered is also an important component.
We are currently investigating the use of patient education videos at Doylestown Health. We can actually order appropriate videos for them on the TV in their hospital room. We enter an order in the medical record, and it comes up on the patient's TV, like a notification that you get on your iPhone, and they watch that video.
Another challenge, in any part of patient care right now, are competing priorities. There are so many things we need to do to ensure we keep our patients safe in the hospital. So making it easy for nurses to obtain the equipment they need for VTE prevention as soon as it's ordered is a great way to prioritize prevention efforts.
Q: How do you and your peers learn in this digital world? What resources are helpful in educating patients and nurses about VTE prevention?
TH: We use a learning management system. As the educator for the critical care areas, I'm able to choose certain videos, competencies or modules, for the nurses to view or complete as part of their annual training. One thing I did last year, as we did a VTE prophylaxis campaign, was to assign all of the nurses a VTE prophylaxis education module. The education is online, and they can do it at home or while at work, whenever they have the time. So for some things, it's a great idea to have just-in-time learning or learning that they can do on their own time.Webinars are another way that I learn. Nurses are required to maintain a number of continuing education credits each year or licensure, even more if they hold a specialty certidication. Webinars arnd on-line learning modules are great for education and earning continuing education credits. At Doylestown Health, we discuss VTE prophylaxis during our multidisciplinary rounds. If there are questions or issues, we conduct just in time education about the topic. Education about a current patient during rounds or reviewing past cases that are relevant to the nurses foster engagement and makes the information more meaningful. We are also exploring other ways to have training with very short videos. Cardinal Health's website has quick, two-minute videos that are really great. These videos go over guidelines, but also provide knowledge about the devices that nurses are placing on their patients. For every piece of equipment that we use here in the hospital, I encourage the nurses to "Know your equipment." Know what it's doing. Know how to troubleshoot it. Know how it works. When they know how and why a device is used, nurses are empowered to really advocate for their patients.
To learn more about Cardinal Health and access the VTE prevention resource center, click here.