Increasing Compliance with VTE Prophylaxis in Post-Surgical Patients: A Quality Improvement Project
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Authors
Paldino, Ashley
Issue Date
2023-02-04
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Abstract
Background: Venous thromboembolism events (VTEs) are a leading cause of death with up to 70% being considered as preventable if VTE prophylaxis is ordered. Approximately 1 to 2 adults per 1000 per year will be diagnosed with a VTE with over 50% of these being attributed to hospitalization and surgery. Missed VTE prophylaxis is a significant contributor to VTE occurrence with the leading indicator being patient refusal. Furthermore, ineffective communication between nurses and providers regarding VTE prophylaxis refusal is a root cause of inappropriate treatment.
Purpose/Aim Statement: Development, implementation, and evaluation of a standardized algorithm regarding VTE prophylaxis by December 2022 in adult surgical patients.
Methods: Pre-implementation data was collected through retrospective data collection of a six- week period. SICU and NSICU nursing staff education occurred prior to the implementation of the VTE algorithm and EHR enhancement. Surveillance of compliance with the project was assessed via chart audits using the IHI VTE bundle audit tool on a weekly basis. Collected reports provided data on if VTE prevention was ordered, if the patient refused the prophylaxis, if the patient was educated, and if the provider was notified of the refusal. Data on VTE occurrence rates was also collected at the end of the 6-week implementation period using the project facility’s quality dashboard.
Results: There were 56 patients included in the project from NSICU and SICU. Of those, 15 patients refused their post-procedure VTE prophylaxis at least once during their admission. Compliance with patient education after refusal combined for both units was 86.6%. Compliance with provider notification of refusals occurred less often at 50% for NSICU and 22% for SICU. Overall, the number of VTEs dropped from five to one in a 6-week period, however this could be due to multiple factors.
Discussion: The implementation of the algorithm and new documentation components greatly increased compliance with providing patients education on the importance of VTE prophylaxis if they refused. Proper provider notification was still lacking in a large number of cases. A limitation identified was that high staff turnover made it difficult to capture all nursing staff for appropriate education of the VTE algorithm. There was also a relatively small sample size of patients that refused their post-procedure VTE prophylaxis making statistical significance difficult to obtain.
Conclusion: Implications for practice include a standardized algorithm for VTE prophylaxis that addresses patient education, provider notification, and required documentation of VTE prophylaxis refusal that may lead to a decrease of VTEs in the post-surgical population.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University