Addressing common areas of VTE prevention failure

Contributor

Wynne Parry

Essential Insights contributor, healthcare writer

How VTE prevention often falls short

of surgical patients receive appropriate prophylaxis

of medical patients receive appropriate prophylaxis

The problem	How to address it
No standardized protocol or order sets.	Implement an institutional protocol. Embed VTE protocol in order sets.
Too many order sets.	Evaluate all order sets and consider streamlining the number in use.

The problem	How to address it
Inadequate guidance.	Provide specific guidance for each set of risk factors. Use explicit operational definitions.
Guidance bypassed.	Implement hard stops. Require risk assessments prior to any prophylaxis order.
Guidance used incorrectly.	Educate caregivers around correct usage. Refine order sets to clarify guidance.

The problem	How to address it
Prophylaxis not administered.	Provide ongoing nurse education. Conduct regular compliance audits.
Inadequate mobilization.	Implement progressive mobility programs. Compare activity orders with actual performance in flow sheets. Educate providers and patients about mobility recommendations.
Excessive central venous catheterrelated VTE risk.	When possible, minimize use of central lines and use small caliber lines. Ensure proper placement and maintenance of central lines.

The problem	How to address it
Patient refuses.	Engage patients, including by explaining risk assessment results. Educate them using the teach back technique.

The problem	How to address it
Prophylaxis missed.	Hard stop for reassessment and corresponding adjustment orders for all transfers.

The problem	How to address it
No adjustment is made.	Integrate prophylaxis reassessment into checklists. Audit to ensure assessments are updated. Create electronic alerts notifying providers of changes to VTE risk.

The problem	How to address it
Prophylaxis stopped too soon.	Identify patients needing extended intervention. Ensure patients get an extended duration prophylactic agent before leaving.

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