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Just how far do patients need to walk?
Contributor
Laura Mueller
Essential Insights contributor, healthcare writer
Featured expert
Jane Lacovara, MSN, RN, CMSRN
Clinical Nurse Specialist, Banner University Medical Center
Common misconceptions that can lead to higher venous thromboembolism (VTE) rates.
Working to prevent VTE in hospital and home settings requires not just knowing what needs to be done, but also a deep understanding of why. From what constitutes “mobility" to the role that ICD compliance—i.e., adhering to ICD billing codes—plays in tracking and preventing blood clots. It's necessary that the approach to VTE prevention is well-defined and adequately communicated. That starts with clarifying the guidelines and the purpose behind each modality.
Just how far do patients need to walk?
When we talk about mobility related to preventing VTE, we mean ambulation. But how much do patients need to walk to be effective at preventing blood clots? While there's data that VTE-prevention programs that incorporate ambulation are effective, there isn't good research on whether it makes a difference if patients ambulate for 5, 15, or 500 feet.
At Banner University Medical Center in Tucson, Clinical Nurse Specialist Jane Lacovara, MSN, RN, CMSRN, met with experts in physical and occupational therapy to determine how much ambulation would be required in the VTE prevention program.
“The PT and OT experts we interviewed ended up defining ambulation in our program as walking at least 50 feet and 3 times a day," Lacovara said, though this distance and frequency are not based on any concrete studies. “The 50-feet rule is helpful because it makes clear that we want patients to be getting outside of their hospital room rather than walking from the bed to the bathroom," Lacovara said.
Other prevention programs that have resulted in lower VTE rates use similar rules of thumb for mobility. At Boston Medical Center, a "patient care program, emphasizing early postoperative mobilization with a mandatory VTE risk stratification and commensurate electronic prophylaxis recommendations, significantly reduced the likelihood of VTE complications among our patients. The VTE patient care program has the same ambulation orders as the center's ICOUGH pulmonary prevention program," said Pamela Rosenkranz, Boston Medical Center's Director of Clinical Quality and Patient Safety. Patients ambulate at least 3 times per day, out of the room and in the hallway, or about 250 feet.
"Ambulation is an area that would benefit from research to define the clinical evidence, as well as the actual number of feet," said Rosenkranz. "That said, we feel ambulation is definitely important for preventing post-op complications (pulmonary, VTE, etc), even if there is no research or literature to define the distance and how often."
To make sure patients get up out of bed to walk, "tell them how far they need to walk and how many times a day they need to do it, but let them choose their schedule." Lacovara said. Timers and pedometers are useful for measuring progress, and visual cues in hospital hallways can help everyone better understand what 50 feet really looks like.
Mechanical compression with pharmacological prophylaxis makes all the difference
Intermittent Pneumatic Compression (IPC) devices (ideally in combination with pharmacological prophylaxis) may also reduce the chance of a VTE event, Lacovara said.
In patients who were contraindicated for pharmacological intervention, IPC devices were more efficient and resulted in better patient compliance during a hospital stay than graduated compression stockings. In terms of deep vein thrombosis (DVT), for example, the same research shows that IPC, on its own, reduces risk by 50 to 60 percent when compared to no intervention.
“For the majority of the patients, we only have them use the IPC devices and not the stockings," Lacovara said.
"There are patients who can't have chemical prophylaxis," Lacovara added, "and for them the [IPC] devices are even more important."
Collect the right data to help prevent VTE
ICD compliance is not a check-the-box exercise to adhere to billing requirements — it's a method of tracking patterns in clotting incidences, which can ultimately help predict acute VTE and save lives. ICD compliance, then, helps ensure that providers do all they can to protect their patients from VTE.
- Compliance means not only tracking data, but making sure the right data is being collected. For VTE, this includes incidences and outcomes, as well as treatment data codes.
- ICD-10 provides more classification options than ICD-9 in order to better specify and monitor the data points that help assess the incidence, epidemiology and outcomes of diseases.
- Robust ICD-10 data helps uncover important relationships between causes and effects. It also illuminates the connections between specific treatment modalities and outcomes.
Mobility, mechanical or chemical prophylaxis, and data afforded by ICD compliance are all incredibly useful tools that health systems have for helping to prevent VTE. The more standardization there is in defining these tools and the more healthcare providers understand why they're a necessity, the better equipped they are at reducing incidences of VTE.
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