This is the first article in a four-part series on the prevention of venous thromboembolism (VTE) and participation in the 2014 Canadian VTE Audit. Watch for upcoming articles at www.patientsafetyinstitute.ca
In 2005, the Jewish General Hospital (JGH) was one of the first hospitals in Canada to develop and implement a hospital-wide thromboprophylaxis policy, and in 2012 its Centre for Excellence in Thrombosis and Anticoagulation Care was inaugurated.
Various processes are in place to ensure preventative measures are appropriately prescribed and implemented. For instance, a clinical pharmacist participates in weekly rounds, helping healthcare teams verify that the appropriate prevention has been undertaken for all patients at risk for venous thromboembolism (VTE) and assess for contraindications.
The Jewish General Hospital has participated in the Safer Healthcare Now! Canadian Venous Thromboembolism Audits since their inception in 2009 and was keen to participate again in 2014. Co-Chairs -Jessica Emed, Clinical Nurse Specialist (Thrombosis) led the audit for medical units, and Hetal Patel, Nurse Educator (Surgery) was responsible for auditing surgical units. The Co-Chairs worked through the audit process together to determine a system for hospital-wide audits, incorporating elements of the Safer Healthcare Now! process and adding a number of indicators they were interested in tracking with the assistance of the quality program.
“The VTE audit tool available through Patient Safety Metrics is very straightforward and easy to use,” says Chantal Bellerose, Quality Improvement Advisor and Accreditation Coordinator. “It includes all the relevant measures to audit and benchmark. The teams and leaders deserve sincere congratulations!”
For the October 2014 National VTE Audit, data was gathered on four units, two surgical and two medical, with overall results of appropriate prophylaxis being administered about 90 per cent of the time. The surgical units use pre-printed order sets, while at present, the medical units do not. The results indicated little difference in the administration of prophylaxis with, or without the use of order sets, however it is a priority to develop pre-printed order sets for the medical units to facilitate and optimize prophylaxis as much as possible.
Co-chairs Jessica Emed and Hetal Patel, with unwavering support and guidance from their medical lead Dr. Susan Kahn and the interdisciplinary team, have successfully showcased the importance of thrombosis prevention over many years. Since 2006, the month of March has been dedicated to deep vein thrombosis (DVT) prevention with education and awareness-building activities for both staff and patients.
“Due to the commendable efforts of this team, VTE is recognized as one of the Jewish General Hospital’s key quality indicators with results posted on the hospital’s Quality Indicators webpage,” states Markirit Armutlu, Quality Program Coordinator. “Participation in the VTE National audits and support from Safer Healthcare Now! over the years have helped further energize and sustain the continuous quality improvement activities of the JGH’s VTE – Thrombosis Prevention Team.”
“Before participating in these audits, we had certain assumptions on how well we were doing,” says Jessica Emed. “Throughout the years we have been able to shed light on where the gaps are and have made improvements. We have been able to increase awareness and create a lot of engagement and energy into the prevention of VTE.”
Last year, the JGH standardized the timing for prophylaxis, and administration at 6:00 pm daily was expanded from a few high-user units, to units across the hospital. “By standardizing administration to later in the day, we did not have to hold the dosage all day while waiting for a procedure that was tentatively scheduled or risked being cancelled,” says Jessica Emed. “As a result we were able to give timely prophylaxis later in the day. As well, we did not have to cancel as many surgical procedures due to prophylaxis having been given earlier in the day. There is always flexibility in the process, however, recognizing that patients come out of surgery at different times during the day. If a nurse adjusts the timing of the first dose in relation to surgery, it is noted on the patient’s medication administration record.”
The JGH policies on the administration of prophylaxis are continually reviewed to ensure they are current. The Jewish General is now re-examining the use of mechanical prophylaxis to ensure it is consistent and evidence-based.
“With every audit we do, we find new information,” says Jessica Emed. “Whether it is confirming that we are doing things right, or finding areas where we need to tighten the screws and aim for better results, our goal is to provide the structure and help our people to work together to improve care for our patients.”
The JGH was awarded the Safer Healthcare Now! Hospital Award for VTE prevention in 2010. In partnership with Sanofi Canada, the JGH created the Centre for Excellence in Thrombosis and Anticoagulation Care in 2012, with a mandate to provide leadership and guidance to other healthcare institutions in Quebec. The JGH received an Exemplary Standing Accreditation decision in 2012-2013.
Click on the links below to view more articles in the series: Southlake Regional Health Centre and Queen Elizabeth Hospital outline how pharmacists led their organization’s participation in the Canadian VTE Audit; Capital Health is engaging frontline staff in auditing; and how the Patient Safety Metrics tool is helping to facilitate quarterly VTE audits in Alberta.