Decreasing Deep Venous Thromboembolic Events in Postsurgical Patients

1. Decreasing Deep Venous Thromboembolic Events in Postsurgical Patients

2. Where the problem lies… • When untreated, general postsurgical patients risk for Deep Venous Thrombosis (DVT) is 19%-25% (Buckner, et al., 2013). • Post surgical orthopedic patients are at a higher risk for DVT than other post surgical patients (Buckner, et al., 2013) • Consulted surgeons are expecting the primary physician to write orders for Venous Thromboembolism (VTE) prophylaxis

3. Where the problem lies… • Surgeons continue to omit orders for VTE on post surgical patients • Nurses do not follow up on obtaining needed orders when the surgeon does not write for VTE • Patients are non compliant with mechanical VTE

4. Committee Members • Surgical Services Manager • Medical Director • Operations Coordinator of peri-anesthesia services • Nurse representative from peri-anesthesia services • Secretary • Adult Services Manager • Operations Coordinator of each surgical floor • Nurse representative from each surgical floor • Secretary

5. Action Plan • Committee members will meet bi-weekly to discuss issues and potential options • Discuss the impact of improving the use of proper VTE prophylaxis for post surgical patients • VTE should start in the holding room • VTE should continue in the surgical suite • PACU nurses should obtain orders post-operatively for both chemical and mechanical VTE or obtain a contra-indication

6. Action Plan • Monitor hospital policy and protocol for providing patients with the proper VTE for their surgical procedure • Continue to review the literature for updated information that effects progress and decreases mortality and morbidity • Educate the patient on the reasons behind the process with medication education for chemical prophylaxis

7. Action Plan • Develop an user friendly “check off sheet” that stays with the chart so that nurses from the holding room through the surgical floor make sure the proper VTE is ordered and performed. • Develop a timeline in which compliance for orders for VTE on post surgical patients becomes 100%

8. Suggested process for physician orders based on best practice and contraindications to chemical and mechanical prophylaxis

9. Effects on patient outcomes • Appropriate use of venous thromboembolism prophylaxis reduces all-cause mortality and/or morbidity associated with surgical procedures and/or hospitalization (National Guideline Clearinghouse, 2012). • Decrease the amount of post-surgical DVTs and pulmonary embolism

10. Patient & Family “Buy-In” • We have to educate the patient and the family properly to ensure their compliance • Fear can be eliminated by proper education on the anticoagulant • Compliance increases when people understand the “why we do what we do” • It is more cost effective to prevent a DVT than to treat it

11. References • Buckner, T., Leavitt, A., Ragni, M., Eyster, M., Kempton, C., & Key, N. (October, 2013). Postoperative deep vein thrombosis (DVT) in patients with hemophilia undergoing major orthopedic surgery. Blood Journal, 122(21). Retrieved from http://bloodjournal.hematologylibrary.org/content/122/21/207.short • National Guideline Clearinghouse. (November, 2012). Venous thromboembolism prophylaxis. Retrieved from http://www.guideline.gov/content.aspx?id=39350&search=vte