VTE Prevention in Medical and Surgical Patients
Steps for improving the prevention of VTE for medical/surgical hospitalized patients:
- Is the patient at increased risk for VTE (i.e. is thromboprophylaxis indicated)?
- Is anticoagulant thromboprophylaxis contraindicated?
- Provide appropriate thromboprophylaxis (anticoagulant or, if anticoagulant contraindicated, mechanical).
- Reassess if significant change in patient status and at transitions of care.
Safer Healthcare Now!
VTE Getting Started Kit (Safer Healthcare Now!, 2012) includes Appendix Q: VTE Pocket Card with detailed information relative to the four steps for improving the prevention of VTE and additional information related to recommended doses of anticoagulant prophylaxis.
VTE Prevention in Obstetrical Patients
It is generally agreed that universal postpartum thromboprophylaxis is neither cost-effective nor recommended. In weighing the risks of treatment, it is recommended to use an absolute VTE risk of greater than one per cent in considering thromboprophylaxis during pregnancy and postpartum (Chan et al., 2014). For specific recommendations for VTE thromboprophylaxis in obstetrical patients refer to the Society of Obstetricians and Gynaecologists of Canada (SOGC) 2014 Clinical Practice Guidelines (Chan et al, 2014).
- Individual risk assessment for venous thromboembolism should be performed prior to all pregnancies, once pregnancy is achieved, and repeated throughout pregnancy as new clinical situations arise (SOGC, 2014).
- Women at increased risk should be advised of the symptoms and signs of venous thromboembolism (SOGC, 2014).
- Good hydration and mobilization should be encouraged for every woman postpartum (SOGC, 2014).
Conduct Clinical and System Reviews (see details below)
Given the broad range of potential causes of this clinical group, in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.
Clinical and System Reviews, Incident Analyses
Occurrences of harm are often complex with many contributing factors. Organizations need to:
Measure and monitor the types and frequency of these occurrences.
Use appropriate analytical methods to understand the contributing factors.
Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.
Have mechanisms in place to mitigate consequences of harm when it occurs.
To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for analysis methods are included in Resources for Conducting Incident and/or Prospective Analyses section of the Introduction to the Hospital Harm Improvement Resource.
Chart audits are recommended as a means to develop a more in-depth understanding of the care delivered to patients identified by the HHI. Chart audits help identify quality improvement opportunities.
Useful resources for conducting clinical and system reviews: