Venous thromboembolism (VTE) is a common complication of hospitalization, with an estimated 600,000 cases in 2002, and is associated with substantial morbidity and mortality. The increasing focus on patient safety, with both financial implications and reporting requirements have created strong incentives to improve performance. We used the Society of Hospital Medicine (SHM) quality improvement guide to facilitate our own VTE prevention initiative and have achieved marked performance improvement within an all‐paper order and documentation environment.
In May 2008, we established a multidisciplinary team to measure current VTE performance and improve future performance. Although VTE decision support existed, it was visually complex and not effectively integrated into work flow. We first focused on simplifying the risk stratification and decision support and integrating it smoothly into order sets. We also established a dashboard that included both rates of appropriate prophylaxis via random chart audits as well as incidence of preventable hospital acquired VTE as determined by reviewing all charts with ICD‐9 codes reflecting PE or DVT. Our first admitting order set was available in July 2008. By September 2009, we had embedded VTE decision support in virtually all admitting order sets as well as postoperative order set. Other quality improvement (Ql) layers have included: physician education via medical staff business meetings, QuantiaMD webinars, and direct feedback via chart audits; nursing education via adding material to annual competency exam; and direct feedback from pharmacy audits; rearranging all units so that order sets are clearly marked and uniformly available; and creating accountability via reporting all metrics to our ongoing professional practice evaluation committee.
Table 1 illustrates data collected July‐October 2008 compared with July–October 2009. Over this period, the rate of appropriate prophylaxis increased by 25% (from 49% to 74%) and rate of VTE order set use increased by 26% (from 19% to 45%).
Using methods and materials provided by SHM we improved our rates of appropriate prophylaxis. Many of our Ql layers have been recently added, and we hope this will further leverage our efforts to achieve greater than 90% rates of appropriate prophylaxis.
p. Tailor, none; B. Hohmuth, none.
To cite this abstract:Tailor P, Hohmuth B. Prevention of Venous Thromboembolism: improving Rates of Appropriate Prophylaxis. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 145. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/prevention-of-venous-thromboembolism-improving-rates-of-appropriate-prophylaxis/. Accessed September 22, 2019.