How We're Fighting VTE - and Winning

Patient Safety

By: Melissa LeCuyer

Published: 10/14/2019

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Our prevention protocol reduced VTE incidents by 42% in 7 months.


Are your facility's venous thromboembolism (VTE) rates higher than the national standard of 3.72 events per 1,000 patient discharges? In 2016, our VTE rate rose above that national benchmark and continued to climb into early 2018.

To reduce our VTE rate, we relied on the expertise and insights of an interdisciplinary clinical team. After implementing the team's recommendations, the VTE rate began trending downward from the highest rate of 10.01 in January 2018 to 5.5 in July 2018 — a 42% reduction. Our current rate has dropped even lower to 1.41. Here's how we achieved those impressive results.

1. Coordination is key

The success of our VTE reduction efforts would have been impossible without a team approach across multiple disciplines, physician and staff engagement, and executive support. We gathered input and provided education to clinical leaders and directors, surgeons, hospitalists, emergency department physicians, quality partners and frontline staff.

You need to make sure that every disciplinary piece of your VTE puzzle is engaged and informed during this process.

2. Mind the gaps

PUMP AND GO Mobile sequential compression devices keep blood flowing to the extremities as patients move from pre-op to PACU.

Identify gaps that could be increasing the patient's risk for developing VTE. Our hospital's VTE committee reviewed our protocols and asked important questions that led to process improvement: What are we currently doing? What should we keep doing? What are some new ideas? What are some ideas that won't work, or can't work, or need to put on the back burner?

Because of the urgency of our situation, we decided to focus on low-hanging fruit — namely, turning VTE prevention into a nurse-driven protocol, starting in pre-op. This provided nurses the autonomy to make decisions within their scope of practice to improve patient outcomes.

The first intervention was the development and implementation of a nurse-driven sequential compression device (SCD) protocol.

Our surgeons fully supported the use of pre-op SCD application, but delays in obtaining their orders didn't always lead to timely application. The literature shows that SCDs should be on in pre-op, but in too many cases we weren't getting SCDs on until the patient was in the operating room. This was the first change we implemented, and it paid dividends. It eliminated having to wait for surgeons' orders on the day of the procedure.

With administrative support, we added additional SCD pumps in our perioperative space. This allows for SCDs to be applied and running in pre-op. The OR nurse will then hook them up in the OR to run throughout the course of the procedure. When the patient goes to recovery, the SCDs can be hooked back up again.

4. Patient compliance

SCDs certainly are not always comfortable, but they are necessary. That is why patient education is an important part of a VTE prevention protocol. Focus on how you can train your nurses to educate patients as to why SCDs or chemoprophylaxis is needed for safety purposes. Fully inform patients about what a blood clot is, what the SCD or blood thinner does, and how VTE can be a serious and potentially life-threatening complication.

It's important to review and assess documentation related to patient refusal of SCDs, including follow-up documentation of patient education performed and physician notification of the refusal. With nurses educating patients on the importance of SCDs, we have seen the number of patients refusing to wear SCDs decreasing.

5. Effective communication

PEER PRESSURE Understand your frontline nurses' workflow, and effectively integrate VTE prevention into it.

Include SCD checks throughout the course of the perioperative phase. Questions to ask include: Were SCDs ordered? Are the SCDs on?

Ultimately, to be successful in this area, you need to understand your frontline nurses' workflow and effectively integrate VTE prevention into it. Give them autonomy and enable them to provide this safe care for the patient. At the end of the day, VTE prevention is about ownership and accountability.

Striving for perfection

We continue to improve and sustain our VTE rate at or below the benchmark level. Keeping it top-of-mind is achieved through consistent engagement and communication, providing feedback related to missed opportunities, drilling down on a VTE or near miss event, and celebrating wins. Our VTE committee continues to be vigilant and proactive in order to maintain and improve the safety of our patients. OSM