A Venous
Thromboembolism
Prophylaxis Strategy
Janice Wright, RN-EC, MS, ACNP(C)
Sandra Robinson, RN, MN
Hotel Dieu Shaver ...
Background
• Hotel Dieu Shaver Health and Rehabilitation Centre (HDSHRC) is a
134 bed regional community-based complex car...
The Challenge
• To critically appraise current evidence
and consider how the various
studies, guidelines, and
recommendati...
The Process

Medication Reconciliation
on Admission

Charge Nurse identified
VTE prophylaxis in use from
sending organizat...
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A venous thromboembolism prophylaxis strategy hotel dieu shaver health and rehabilitation centre

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A venous thromboembolism prophylaxis strategy hotel dieu shaver health and rehabilitation centre

  1. 1. A Venous Thromboembolism Prophylaxis Strategy Janice Wright, RN-EC, MS, ACNP(C) Sandra Robinson, RN, MN Hotel Dieu Shaver Health and Rehabilitation Centre
  2. 2. Background • Hotel Dieu Shaver Health and Rehabilitation Centre (HDSHRC) is a 134 bed regional community-based complex care and rehabilitation facility that is not linked with an acute care hospital • Patients are admitted to HDSHRC from a variety of acute care facilities from within and outside our region and require rehabilitation or restorative care related to a variety of neurological, orthopedic, and medical conditions • Venous Thromboembolism (VTE) is a common preventable complication of hospitalization and prophylaxis is required for patient safety • The American College of Chest Physicians 2012 Guidelines is the current “gold standard” based on evidence and expert review • A paucity of research specific to the rehabilitation population and the current guideline document excludes rehabilitation from the recommendations
  3. 3. The Challenge • To critically appraise current evidence and consider how the various studies, guidelines, and recommendations fit our in-patient population • Patients are transitioning earlier to rehabilitation and restorative care from the acute care sector and may or may not have VTE continuation orders that accompany them from the sending organization • To provide appropriate VTE prophylaxis for patients based on standardized risk assessments in a safe, cost-effective and efficacious way to prevent VTE Creating the Structure • Development of: • A VTE prophylaxis policy • Risk assessment tools • Guidelines for VTE Prophylaxis • A VTE prophylaxis order set *External expert review completed for content validity and applicability with revision based on expert opinion • Care is organized such that: • A stepped approach is utilized based on available evidence and expert opinion • An inter-professional approach is utilized that involves pharmacy, nursing, medicine, and therapist’s knowledge of the patient. • A database was created with the assistance of an exchange medical student to enhance our ability to describe our population & record the presence of VTE prophylaxis adverse events and outcomes
  4. 4. The Process Medication Reconciliation on Admission Charge Nurse identified VTE prophylaxis in use from sending organization Charge Nurse does not identify VTE prophylaxis in use Charge Nurse documents VTE prophylaxis on the reconciliation documentation MRP alerted to assess risk for VTE and document on the VTE order set when completing the admission process Implementation • Representatives of all involved professions contributed to the development of tools and process in order to obtain maximum buy-in • Education provided to all team members • Key data elements relative to population collected preimplementation Next Steps Pharmacy notified that existing VTE prophylaxis is to continue MRP to complete VTE prophylaxis order set within 48 hours Weekly review of need for VTE prophylaxis at Team Rounds Weekly review of need for VTE prophylaxis at Team rounds • Continue rapid cycle improvement methods • Enhance our existing audit and review processes
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