Preventing VTE in Surgical Patients

Preventing VTE in Surgical Patients

Today’s Topics • The common sense science of VTE prevention • Brief history of VTE prevention techniques • High yield methods of preventing VTEs in surgical patients • A glance at the reporting requirements for VTE • Understanding your needs: A series of polls

Why Are We Focusing In Surgery?

Common Sense Science: Venous Thromboembolism (VTE) • When blood clots form in the vein and form a mass • Two types: • Deep Vein Thrombosis (DVT): occurs in leg veins (clot that forms in the deep veins of the body) • Pulmonary Embolism – occurs when a clot detaches from the vessel and travels to the lungs and lodges within the pulmonary arteries • DVT + PE = VTE

Common Sense Science Continued • ~ 300,000-600,000 Americans develop VTE each year • 60,000-100,000 die each year from VTE • Annual cost of care is estimated at $1.5 billion • About two-thirds of all VTE events are related to hospitalization • 40% or more of hospital associated VTE is preventable through prophylaxis U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism: 2008. Office of the Surgeon General and the National Heart, Lung, and Blood Institute of the National Institutes of Health; 2008. Available at: http://accpstorage.org/chest08/bestOF/SurgeonGeneralsReport.pdf. Accessed July 31, 2009.

Venous Thromboembolism: A Brief History Rudolf Carl Virchow 1821-1902

Virchow’s Triad Stasis of blood flow (blood slows down) State of the body (Hypercoagulability) Injury to the vein

VTE Main Risk Factors • Trauma • Inflammatory bowel syndrome • Atherscelerosis • History of DVT or PE • Inherited or acquired predisposition to clotting • Obesity • Pregnancy and postpartum period • Oral contraceptive or hormone replacement with estrogen • Varicose veins • Increasing age (risk rises steadily from age 40) • Prolonged/restricted mobility • Cancer and cancer therapy • Cardiac problems • Systemic lupus erythematous • Infection • Microalbuminuria associated with ESRD • Stroke • Nephrotic syndrome

The Greatest Risks for VTE • The trauma of surgery itself • Prolonged/restricted mobility • Length of the surgical procedure

The Most Important Question to Ask “Is this patient going to be in bed for a long time?”

Surgical Patients at Risk for VTE

Prophylaxis Options

Preventing VTE Is Complicated(Slide 1 of 3) Hight, Henrietta. Venous Thromboembolism & Prophylaxis in the Surgical Patient. FMQI. http://www.hsag.com/App_Resources/Documents/FMQAI_SCIP_VTE_LearningModule.pdf. 27 June 2013

Sample Order Set Sample order sets are available at: http://www.fmqai.com/library/attachment-library/VTERiskAssessmentTools.pdf

Work within a Specialty

Surgical Care Improvement Project (SCIP) Measures VTE Measure 1: Surgery patients with recommended venous thromboembolism (VTE) prophylaxis ordered anytime from hospital arrival to 24 hours after Anesthesia End Time. VTE Measure 2: Surgery patients who received appropriate venous thromboembolism (VTE) prophylaxis within 24 hours prior to Anesthesia Start Time to 24 hours after Anesthesia End Time. Centers for Medicare & Medicaid Services (CMS). The Joint Commission. Specifications Manual for National Hospital Inpatient Quality Measures. Version 3.1a. Revised November 6, 2009; 135-177 [SCIP-VTE 1-1 – SCIP-VTE 2-23]. QualityNet Web site. Available at: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier4&cid=1228749003528. Accessed March 8, 2010.

Joint Commission Measures

Poll 1: Realistically, how often do you think that patients receiving surgery in your facility receive treatment that fulfills some of the guidelines that we talked about? • Never • Sometimes • Most of the time • Always

Poll 2: Additional resources from the SCHA to help us further refine our VTE prophylaxis efforts would be helpful? • Yes • No

Poll 3:What do you see as the biggest barrier to more consistent use of VTE guidelines?(Open-ended question)

Take Home Messages • Preventing VTE is complicated and requires interventions across the entire system of care • Creating guidelines/order sets by specialty is helpful • The hospital association would like to learn more about your experiences with VTE please send an email to LorriGibbons at lgibbons@scha.org with: • any successes that you have had • if you have any suggestions for future topics to help further your work in this area

? Questions

Office Hours:Wednesday 2:00-3:00

Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu

Preventing VTE in Surgical Patients