Venous Thromboembolism (VTE) Prophylaxis Policy

1. Venous Thromboembolism (VTE) Prophylaxis Policy Mary-Anne Davies Patient Safety Specialist Accreditation Coordinator

2. Background – VTE Prophylaxis Project Project Purpose • To create corporate policy/guidelines for the assessment of VTE risk for every hospitalized patient and recommended interventions for thromboprophylaxis based on the risk factors for VTE development.

3. What is VTE? • VTE is Venous Thromboembolism • Includes deep vein thrombosis (DVT) and pulmonary embolism (PE) • DVT is a blood clot that forms in the deep vein in the leg • PE is a clot that has broken off and traveled to the lungs DVT +/- PE = VTE

4. Why is VTE Important? • VTE is one of most common and preventable complications of hospitalization • The rate of hospital-acquired VTE is 10 - 40% after general surgery and 40 - 60% after hip surgery if thromboprophylaxis is not used • DVT or PE is associated with increased mortality, increased length of stay • Accreditation Canada has made VTE Prophylaxis a Required Organizational Practice (ROP)

5. VTE Prophylaxis Policy • LHSC assesses all patients for the risk of VTE using the Identification of Patients at Risk for VTE (Appendix A) upon: • admission to hospital • a significant change* in clinical status • any Transition Point in care, including discharge * Examples include change in activity status – ambulatory to bedrest; becoming more acutely ill; decrease in bleeding risk.

6. Risk Assessment – Appendix A

7. Risk Assessment – Who and When • Conducted by the Most Responsible Professional (MRP)/delegate at: • time of admission • discharge. • Conducted by the MRP/delegate OR another member of the health care team (HCT): • throughout hospital admission – transitions in care and changes in clinical status

8. Appropriate Prophylaxis • All patients who are identified at risk for VTE are provided with optimal, evidence-based thromboprophylaxis based on completion of: • LHSC VTE Prophylaxis Risk Assessment/Preprinted Order for Non-Intensive Care Unit (ICU) patients (Appendix B) OR • Preprinted order appropriate for the patient’s reason for admission (e.g. Orthopaedic Hip Fracture Admission Preoperative PPO) (See list - Appendix C)

9. Prophylaxis • Pharmacological prophylaxis • Low molecular weight heparin (LMWH) • Low dose unfractionated heparin • Other anticoagulant • Mechanical prophylaxis • For patients with high risk of bleeding • Intermittent Pneumatic Compression (IPC) devices with or without Anti-embolic stockings (TEDs)

10. Steps for Determining VTE Prophylaxis Venous thromboembolism prophylaxis is a three step process which includes: • Determining if VTE prophylaxis is required (guidelines provided in Appendix A). • Determining if VTE prophylaxis is contraindicated, considering both pharmacological and mechanical prophylaxis options, where applicable (guidelines provided in Appendix A) • Determining and providing the appropriate prophylaxis for eligible patients. (guidelines provided in Appendix B or C)

11. Patient Education • Important to educate patients on their risk and how to prevent VTE • Pamphlet available and can be accessed through website

12. Staff Resources • Website http://www.lhsc.on.ca/priv/VTE/ • Staff presentations • Poster • Reminders that can be posted on all computer terminals

13. Questions? Mary-Anne Davies – ext. 52280 or email maryanne.davies@lhsc.on.ca