Venous thromboembolism (VTE) is a leading cause of hospital deaths in the U.S., but about 70 percent of healthcare-associated VTE cases are preventable with the right team and data approach.
During a March webinar hosted by Becker's Hospital Review and sponsored by Cardinal Health, Amy Campbell, PhD, RN, discussed how working collaboratively with multidisciplinary stakeholders and drawing insights from facility and patient case data can decrease VTE rates.
Three insights:
- VTE is concerning for patients, expensive for organizations — and largely preventable. VTE, which may manifest as either deep vein thrombosis (DVT) or pulmonary embolism (PE), accounts for up to 100,000 deaths in the U.S. each year. Despite this alarming statistic, only one in 1,000 cases are diagnosed despite more than $15 billion spent annually to address this condition. VTE often occurs after surgery and the risk is elevated in people over age 65.
- To mitigate VTE risk, bring together the right people and data. To manage VTE risk, it is important to align at a strategic level by putting together a multifaceted team and giving them access to relevant, high-quality data. The team — which Dr. Campbell suggested may be thought of as a "VTE taskforce" — should include a strong physician champion, a bedside nurse, other patient-facing staff, a quality nurse specialist to oversee the work (and "double" as a clinical expert, if needed) and a nursing executive or other leader to push through any organizational barriers. "These are the people who are going to help get things done," Dr. Campbell said.
As far as data, VTE prevention teams should have access to three main categories:
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- Preventive data: data related to VTE prophylaxis, provision and withholding of anticoagulant medicine, intermittent pneumatic compression (IPC) compliance and discharge instructions
- Post-event data: data related to reporting structures (How do you find out when you have a PE or DVT on your unit? Can you find that out in less than 24 hours?), drill-down processes, data-collection mechanisms and tools, EHR support and data repositories from partners such as Vizient or Premier
- Organization impact data: data related to VTE rates, readmissions, length of stay, mortality, transfers to the intensive care unit (ICU) and cost
- Using data to generate creative solutions guides continuous improvement. Once VTE risk is monitored and managed by having access to the right data, teams can implement creative solutions to track patients' health status through discharge. Those solutions may include:
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- Using bedside whiteboards to note the frequency and level of mobility
- Having "star walks" to reward patients for moving frequently and sufficiently
- Involving family members to help patients achieve passive-active range of motion
- Deploying stationary bikes for patients who cannot utilize IPC
- Holding friendly competitions between VTE team members to keep each other engaged and accountable
To support VTE teams, organizations may also designate "clot busters" — advocates for facility-wide VTE prevention – who monitor data and prophylaxis compliance at the patient level, make sure that physician orders are filled, and reinforce VTE prevention importance with others — peers and patients alike. "They go in, do the bedside shift report, check compliance and call the question: Did Mr. Smith get his Lovenox today? Mr. Smith is lying right there [and if] he says no, now he's got two nurses to talk to him about the importance of compliance," Dr. Campbell said, illustrating the key role of clot busters in helping patients on their way to recovery — and organizations on the path to excellence.
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