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Venous Thromboembolism

By: Anthony Paguyo, Todd Shumway, Reina Fujiwara, Virginia Small, Chris Hillman, Christine Rombawa

What is VTE?

PDCA (IHI) Quality Improvement Model


Plan:

In addition to the existing prophylaxis techniques, we would recommend utilizing a risk


assessment tool, and a clinical protocol that includes duplex screening exams for high risk patients. It
would benefit the patient by identifying DVTs earlier and decrease the progression to PE in a cost
effective way.

Do:

Upon admission, complete risk assessment card to guide the prophylaxis treatment and clinical
protocol that includes the use of serial duplex exams for high risk patients. Use flowcharts and run
charts to collect data, interpret results, and evaluate effectiveness of change and compare with
previous surveillance period. Track adherence to mechanical prophylaxis, anticoagulants, ambulation,
SCDs, serial duplex exams, and patient education. Make refinements to the plan as needed by
providing in-services for providers and clinical nursing staff, along with updating staff on the results of
audits, and seeking input regarding barriers or/and improvements to workflow process.

Check:

Performance tracking is an important component to a Quality Improvement Program. Various tools,

such as flowcharts and run charts, may be used to collect data, interpret results, and implement improvement
actions and evaluate effectiveness.Tracking adherence to mechanical prophylaxis, anticoagulants, ambulation,
and patient education is also important. Performing daily visual checks by the Charge Nurse and conducting
audits weekly of the EHR will aid in the effectiveness and evaluation of the VTE prophylaxis quality
improvement program. Providing in-services for providers and clinical nursing staff will also be beneficial, along
with updating staff on the results of audits, and seeking input regarding barriers or/and improvements to
workflow process.

SCDs
What is it?
Pros vs Cons
Data on effectiveness of
treatment

Medications
INITIAL THERAPY

LONG TERM

Unfractionated Heparin

Vitamin K Antagonists (Warfarin) (LT)

Low Molecular Weight Heparin

Aspirin

Factor Xa Inhibitors

Clopidogrel

Direct Thrombin Inhibitors

Duplex Exam
A duplex ultrasound combines traditional ultrasound with Doppler ultrasound.
Traditional ultrasound uses sound waves that bounce off blood vessels to create pictures.
Doppler ultrasound records sound waves reflecting off moving objects, such as blood, to measure their
speed and other aspects of how they flow.
A transducer sends out the sound waves. A computer measures how the sound waves reflect back, and
changes the sound waves into pictures. The Doppler creates a "swishing" sound, which is the sound
of your blood moving through the arteries and veins.

CASE STUDY
60 year old man, POD 1 for total hip replacement. He has
history of smoking, and he is overweight.
As his nurse, what can we do to prevent VTE from
occurring?

Patient Education
Assess the patient
Early ambulation
Ankle pumps
Encourage adequate hydration.
SCD
Signs and symptoms
Risks for non-compliance and benefits of prophylaxis treatment

References
Casey, M., MS., Hung, P., MSPH, Evenson, A., MA, Distel, E., BS, & Mosocovice, I., PhD. (2015, March). Hospital
Compare CAH Quality Measure Results, Q2 2013 - Q1 2014. Retrieved March 28, 2016, from
http://www.flexmonitoring.org/wp-content/uploads/2015/04/Hawaii.pdf
Cherry, Barbara, Susan Jacob. Contemporary Nursing: Issues, Trends, & amp; Management, 6th Edition. Mosby, 2014.
VitalBook file.
Huang, W., Anderson, F. A., Rushton-Smith, S. K., & Cohen, A. T. (2015). Impact of Thromboprophylaxis across the US
Care Setting. PLoS ONE, 10(3), e0121429. http://doi.org/10.1371/journal.pone.0121429

Acute

Malhotra, A. K., Goldberg, S. R., McLay, L., Martin, N. R., Wolfe, L. G., Levy, M. M., & ... Ivatury, R. R. (2014).
Surveillance Program in the ICU: Analysis of Cost-Effectiveness. Plos ONE, 9(9), 1-7.
doi:10.1371/journal.pone.0106793

DVT

Moore, C. (2013). Enhancing patient outcomes with sequential compression device therapy - American Nurse Today.
Retrieved from http://www.americannursetoday.com/enhancing-patient-outcomes-with-sequential-compression-device-therapy
N.A. (2016). VTE prevention. Retrieved from https://www.thrombosisadviser.com/en/.
Sobiera-Teague, M., Hirsh, J., Yip, G., Gastaldo, F., Stokes, T., Sloane, D., Eikelbloom, W. (2011). Randomized
controlled trial of a new portable calf compression device (Venowave) for prevention of venous thrombosis in
high-risk neurosurgical patients. Journal of Thrombosis and Haemostasis, 10, 229-235.
Schreiber, D. (2015). Anticoagulation in deep vein thrombosis. Retrieved from
http://emedicine.medscape.com/article/1926110-overview#a2.