DVT Prevention and Anticoagulant Management

1. DVT Prevention and Anticoagulant Management Aims Measures Literature Data

2. DVT Prevention and Anticoagulant Management • Aims (What are we trying to accomplish?) • Reduce the incidence of DVT and PE in hospitalized patients by 50% in one year. • Reduce readmissions within 31 days for DVT and PE by 50% in one year. • Reduce patient harm associated with the use of anticoagulant therapy by 50% in one year.

3. DVT Prevention and Anticoagulant Management • Measures (How will we know that a change is an improvement?) • Hospital Acquired DVT per 1000 Discharges • Hospital Acquired PE per 1000 Discharges • Readmissions within 31 Days with DVT per 1000 Discharges • Readmissions within 31 Days with PE per 1000 Discharges • Patient harm associated with anticoagulant therapy as measured by the IHI Adverse Drug Event Trigger Tool

4. DVT Prevention • Clinical Goals • Adult patients (18 & older) are assessed for VTE risk within 24 hours of admission • Appropriate pharmacological and/or mechanical prophylaxis begins within 24 hrs of admission. Venous Thromboembolism Prophylaxis, June 2007, ICSI

5. DVT Prevention • Clinical Goals • All patients receive education regarding VTE signs & symptoms, preventive methods • All patients begin early and frequent ambulation Venous Thromboembolism Prophylaxis, June 2007, ICSI

6. DVT Prevention • Clinical Goals • All adult medical/surgical patients with moderate-high-very high VTE risks receive anticoagulation prophylaxis unless contraindicated. • Reduce the risk of complications from pharmacologic prophylaxis. Venous Thromboembolism Prophylaxis, June 2007, ICSI

7. DVT Prevention • Clinical Goals • Appropriate pharmacological and/or mechanical prophylaxis begins within 24 hrs of admission. • Mechanical prophylaxis is used when pharmacologic prophylaxis is contraindicated. • Appropriate precautions for patients receiving spinal or epidural anesthesia are implemented. Venous Thromboembolism Prophylaxis, June 2007, ICSI

8. National Patient Safety Goal 3E: Anticoagulation • Reduce the likelihood of patient harm with the use of anticoagulation (AC) therapy. • Applies to multiple inpatient and outpatient settings • Rationale: Anticoagulation therapy is a high risk treatment Requirement: Reduce the likelihood of patient harm associated with the use of anticoagulation (AC) therapy. Applies to:Ambulatory Care, Critical Access Hospital, Home Care, Hospital, Long Term Care, and Office-Based Surgery.Rationale: Anticoagulation is a high risk treatment (complexity of dosing, monitoring of effects, ensuring patient compliance) which commonly leads to Adverse drug events (ADE’s). Use of standardized practices with patient involvement can reduce the risk of ADE’s.

9. NPSG 3E Implementation Expectations: • Implement a defined AC program • Use ONLY oral UD products/pre-mixed IV’s • Warfarin is dispensed for each patient with established monitoring • Use approved protocols for the initiation & maintenance of AC therapy • Implementation Expectations: • The organization implements a defined AC program to individualize the care provided to each patient receiving anticoagulation therapy. • To reduce compounding and labeling errors, the organization uses ONLY oral unit dose products and pre-mixed infusions, when these products are available. • When pharmacy services are provided by the organization, warfarin is dispensed for each patient in accordance with established monitoring procedures. • The organization uses approved protocols for the initiation & maintenance of AC therapy appropriate to the medication used, condition being treated and potential for drug interactions.

10. NPSG 3E Implementation Expectations: • Warfarin – baseline/current INR • Dietary services notification of pt’s receiving warfarin • Heparin IV by a programmable IV pump • Policy addresses baseline & ongoing lab tests for Heparin/LMWH • Implementation Expectations cont: • For pt’s starting warfarin, a baseline International Normalized Ratio (INR) is available; for all pt’s on warfarin, a current INR is available & used to monitor & adjust therapy. • When dietary services are provided, the service is notified of all pt’s receiving warfarin & responds according to its food/drug interaction program. • When heparin is administered intravenously and continuously, the organization uses programmable infusion pumps. • The organization has a policy that addresses baseline & ongoing lab tests required for heparin and low molecular weight heparin therapies.

11. NPSG 3E Implementation Expectations: • Education for Anticoagulation therapy: prescribers, staff, patients and families. • Pt./family education covers specific areas • Evaluation of Anticoagulation safety practices. • Implementation Expectations cont: • The organization provides education regarding anticoagulant therapy to prescribers, staff, patients and families. • Pt./family education includes the importance of follow-up monitoring, compliance issues, dietary restrictions and potential adverse drug reactions and interactions. • The organization evaluates anticoagulation safety practices.

12. Baseline Measures • Hospital Acquired DVT per 1000 Discharges • Hospital Acquired PE per 1000 Discharges • Readmissions with DVT per 1000 Discharges • Readmissions with PE per 1000 Discharges Time Frame: FY 07