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Things to discuss in a nursing huddle to prevent VTE
Featured expert
Melissa Schmidt
Clinical Nurse Specialist for Neurosciences
Barnes-Jewish Hospital,
Washington University Medical Center
An interview with Melissa Schmidt, Clinical Nurse Specialist for Neurosciences at Missouri's largest hospital.
Each year 350,000 to 600,000 Americans are affected by venous thromboembolism (VTE), and they primarily consistent of those who are hospitalized or were recently hospitalized. Over a 10-year period, about 40 percent of patients have recurrent episodes of VTE.
Barnes-Jewish Hospital at Washington University Medical Center, Missouri's largest hospital, is fighting VTE by training healthcare providers, including clinical nurse specialists, in actionable VTE prevention strategies according to Clinical Nurse Specialist for Neurosciences, Melissa Schmidt.
The nursing huddle is “the best way to share timely, need-to-know information," according to Schmidt.
- Nursing huddles last five minutes and are held twice a day.
- Only the most important information is shared.
- Huddle topics are documented and available for review at the nurses' station for those who weren't present.
To keep information fresh and relevant, each topic is only discussed for one week at a time.
Top VTE nursing huddle topics
Schmidt recommended prioritizing the following topics for VTE discussion in the nursing huddle:
1. The process for what to do if a patient refuses chemical prophylaxis
Thromboprophylaxis can reduce the risk of VTE in at-risk inpatients by 30 to 65 percent. If a patient refuses chemical prophylactic treatment for VTE, the Neuroscience Innovation Unit has an action plan with guidelines on how to coach the patient about prophylaxis. If the patient remains resistant to treatment, the attending physician gets alerted.
2. Educate staff on treatment with intermittent pneumatic compression (IPC) devices
The hospital also uses IPC devices to help prevent VTE. However, patients can be hesitant to use them for various reasons including finding them uncomfortably hot. Clinical nurse specialists can find ways to cool the patient down, such as using cool wash cloths. They should talk to patients about the importance of IPC devices to get patients on board with treatment.
3. Share strategies to get the patient to wear IPC devices 80 percent of the time
Patients need to wear IPC devices for enough time to sufficiently reduce VTE risk. Following industry best practices, Schmidt aims for patients to wear these devices 80 percent of the time, or 20 hours per day. This goal aligns with the American College of CHEST physician's guidelines for prevention of VTE in orthopedic surgery patients
“The best strategy for VTE prevention is using compression devices with a monitor that displays the percentage of the time the patient has been wearing the pneumatic compression device," Schmidt said. This allows clinical nurse specialists to know patient compliance in real time. The assistant nurse manager can then note and track whether a patient has worn the IPC devices 80 percent of the time.
Patient compliance needs to be a team effort between clinical nurse specialists and other hospital staff. This includes understanding why patients are unable to meet the 80 percent goal.
For instance, Schmidt explained, “If a patient travels to physical or occupational therapy, they may not be permitted to wear their IPC device during transport and treatment. Clinical nurse specialists should collaborate with other providers to ensure the pneumatic compression device is put back on the patient after services."
When a patient falls short of the 80 percent goal, clinical nurse specialists must work with the patient to address barriers to compliance, Schmidt said. Information on compliance rates for all patients is circulated within the unit every other month.
A common best practice is to benchmark departments and share high and low performers so that departments can learn from each other.
Clinical nurse specialists are typically competitive with each other and knowing other units' rates motivates nurses to increase their units' compliance efforts. This approach has been successful in the Neuroscience Innovation Unit. “We've met the 80 percent mark 98 percent of the time," Schmidt said.
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