To ensure appropriate venous thromboembolism (VTE) prophylaxis is administered, the Health Sciences Centre North (HSCN) has implemented a stand alone pre-printed order set so that every patient admitted to the hospital has a VTE prophylaxis pre-printed order added to their basic chart. The physician is required to check off and say, “Yes, this is appropriate and this is what I want you to do.” or “No, this is not appropriate for the patient and indicate the reason(s).”
“This is not about getting a drug ordered for the patient, rather it is getting the patient assessed,” says Frances Brisebois, a Pharmacist at HSCN. “It is just as important to know why the patient is not getting a prophylaxis as getting the drug ordered. Audits have indicated that if the patient has a pre-printed order form on their chart, they are more likely to be assessed and receive the appropriate VTE prophylaxis.”
When the hospital joined the Safer Healthcare Now! Venous Thromboembolism Collaborative, STOP THE CLOT it gave them a structure to work with. “These kinds of Collaboratives are very useful to hospitals so that you don’t have to reinvent the wheel,” says Brisebois. “There is a huge wealth of knowledge and ideas out there and once you are part of a group, it gives you access to these ideas and information along with an incentive to keep going and get things done. If I have a question from a physician, I can put it out there to find out what happened when others tried that and you avoid making a mistake or going down a line that would not be as fruitful.”
Prior to implementing the VTE protocol, Dr. Bill Geerts, the lead for the Safer Healthcare Now! VTE intervention presented at Grand Rounds with the HSCN physicians and multidisciplinary team. Immediately before implementation three weeks were dedicated to providing 15 minute in-service training sessions for the nursing staff, explaining VTE and the new protocol. “We got to about 75 per cent of the nursing staff and the buy-in was incredible,” says Brisebois. “The physicians told us the nursing staff were like a dog with a bone after that – if prophylaxis was not ordered, they were sure to follow-up and ask why.”
Brisebois says that an awareness campaign helped to make information on VTE very visible around the hospital. Informational pamphlets were prepared in English and French for patients and the nursing staff. STOP THE CLOT buttons were provided to staff as a reminder and posters were displayed in the hospital cafeteria.
For more information on venous thromboembolism and the VTE Collaborative, STOP THE CLOT, visit www.saferhealthcarenow.ca