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Nurse helping a patient out of her wheel chair.

Addressing common areas of VTE prevention failure

Blood clot prevention

Contributor

Wynne Parry Essential Insights contributor, healthcare writer.

Wynne Parry

Essential Insights contributor, healthcare writer

How VTE prevention often falls short

Fewer than 60%

of surgical patients receive appropriate prophylaxis

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Fewer than 40%

of medical patients receive appropriate prophylaxis

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Common areas of VTE prevention failure:

Identified by the Agency for Healthcare Research and Quality

icon illustration of a hospital.Admission

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Icon illustration of a patient and health records.Risk assessment

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.
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Icon illustration of a doctor and a computer.Prophylaxis ordered

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.
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Icon illustration of a pill bottle and a patient with compression sleeves.Usage

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.
Black down arrow.

icon illustration of a nurse and a patient wearing compression sleeves.Patient compliance

The problem How to address it
Patient refuses.
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icon illustration of a gurney.Transfer

The problem How to address it
Prophylaxis missed.
  • Hard stop for reassessment and corresponding adjustment orders for all transfers.
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icon illustration of a nurse holding health records.Risks change

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.
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icon illustration of home healthcare.Discharge

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.

 

To learn more about best practices in VTE prevention, get our free eBook: Implementing a VTE protocol.