This document describes the development of a venous thromboembolism (VTE) prophylaxis strategy at Hotel Dieu Shaver Health and Rehabilitation Centre. The strategy was created due to the lack of clear guidelines for VTE prophylaxis in rehabilitation patients. It includes a VTE risk assessment tool, prophylaxis guidelines and order set. An interprofessional team created the strategy using evidence and expert review. Implementation involved education and collecting data on VTE outcomes to support ongoing quality improvement.

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. 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. 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. 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