1 in 1000 pregnant women will have a blood clot

The Physician-Patient Alliance for Health & Safety (PPAHS) is an advocacy group dedicated to improving patient health and safety. They recommend to:

• Use IPC for moderate/high/highest risk patients for vaginal and C-section delivery.
• Consider at-home IPC for patients on bed rest or with associated risk.

The Saint Louis University School of Medicine conducted a study comparing the compliance for two IPC devices, foot cuffs and leg sleeves, in the prevention of VTE in antepartum (prior to childbirth) patients which showed poor compliance to wear time for IPC devices. The study was presented at the ACOG 61^st Annual Clinical Meeting (May, 2013).

Working with a group of thought leaders in obstetrics to address the issue of VTE in pregnancy, Thinh P. Nguyen, MD, from Saint Louis University, concludes, “the study demonstrates the need for better awareness and education about how VTE can be prevented, managed and treated during pregnancy.”

1. Admission / transfer of care

• OB VTE risk factor assessment conducted and documented
  • Low risk
  • Moderate risk
  • High risk
  • Highest risk

2. Prophylaxis regimen

Antepartum

• If low to medium risk
  Pharmacological prophylaxis* not recommended unless indicated
  Medium risk - mechanical prophylaxis† prescribed
• If high to highest risk
  • Pharmacological prophylaxis*
    • High risk - ordered if VTE unprovoked and/or thrombophilia and/or hormonally provoked
    • Highest risk - ordered
  • Mechanical prophylaxis^† initiated

Postpartum

• If low to medium risk
  • Early ambulation as prescribed by healthcare provider
  • Pharmacological prophylaxis* not recommended unless indicated
  • Medium risk – pharmacological prophylaxis* considered
  • Mechanical prophylaxis† initiated
• If high to highest risk
  • Pharmacological prophylaxis* (not administered until 12 hours after vaginal delivery/epidural removal or 24 hours after C-section delivery)
  • Mechanical prophylaxis^† initiated

3. Patient reassessment

Repeat assessment if patient hospitalized longer than 24 hours, before surgery or with any significant change in patient condition

• Assess patient for VTE risk and document (see step 1)
• Pharmacological prophylaxis*
  • Continued as prescribed
  • Not ordered, why?
• Mechanical prophylaxis†
  • Not prescribed
  • If prescribed, patient provided with information on proper use and wearing
• Initiate discharge planning
  • Discuss with patient/family
  • Anticipate discharge date determined
• Evaluate patient for home use of:
  • Intermittent pneumatic compression (IPC), or
  • Venous foot pump (VFP), or
  • No IPC/VFP
• If evaluated for IPC/VFP, initiate availability on discharge

4. Patient discharged

• Included in discharge instructions
  • HCP contact information
  • DVT patient education - signs and symptoms
  • Evaluate patient for IPC/VFP home use
• Discharge instructions reviewed with and received by patient
• Patient understands DVT/PE risk factors and how to prevent postpartum DVT or PE
• Follow-up appointment made if immobility or bed rest is required
  • Order completed
  • Identification of IPC/VFP
  • Length of IPC therapy determined
  • DME notified of start date of IPC therapy
  • Review importance of maintaining use at home until discontinued by doctor
  • Removed for ambulation and skin inspections (every 8h)
  • Worn at least 18-20 hours per day for immobile patients