Venous Thromboembolism (VTE)
Venous thromboembolism (VTE) is a disorder that includes deep vein thrombosis and pulmonary embolism, and is one of the most common preventable complications from hospitalization. Patients who develop deep vein thrombosis can experience pain, swelling, and extreme discomfort. Pulmonary embolism can lead to shortness of breath, chest pain, and death. The majority of hospitalized patients are at risk for developing VTE.
VTE is preventable. Establishing methods to provide appropriate thromboprophylaxis to patients based on standardized risk assessments is a safe, cost-effective and efficacious way to prevent VTE in nearly all patient groups.
Providing appropriate thromboprophylaxis for all patients may prevent the pain and discomfort of a thrombus, prevent complications that can extend hospital stays, and even save a life. Our aim is to provide every hospitalized patient in BC with appropriate thromboprophylaxis to help eliminate the incidence of preventable VTE.
VTE prophylaxis will be provided for all patients at risk of VTE, based on the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines 8th Edition1. These guidelines are considered the ‘gold-standard’ for VTE prophylaxis in North America.
Implementation strategies include:
- Establish a regional multidisciplinary committee to guide your VTE prophylaxis implementation strategy throughout your health authority. As a minimum the committee should include an executive sponsor, senior administrative leader, physician champion, pharmacist nurse, and consider inviting patients.
- Develop a regional, written, active policy that requires risk stratification and the ordering of prophylaxis according to guidelines or documentation of deviation from policy.
- Identify clients at risk for VTE using a recommended risk stratification approach at admission and at time of transfer. Embedding a risk stratification tool into pre-printed order sets that can be used at the time of admission or transfer is a proven strategy to achieve maximum compliance with VTE prophylaxis.
- Provide post-discharge prophylaxis for major orthopedic surgery (hip and knee replacements, hip fracture surgery).
- Establish a prospective randomized auditing strategy to monitor compliance with VTE prophylaxis.
- Provide education to health care professionals and clients about the risks of VTE and its prevention.
- Work within your local context to use strategies to increase compliance with your organization’s policy, including the use of computer decision support systems, preprinted orders, auditing and feedback.
In order to achieve these goals, teams working on VTE prophylaxis should set specific goals and target outcomes, measure and analyze data, and revise for continual improvement and sustainability. This can be accomplished using quality improvement processes and methodology.
- Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 2008; 133:3815-4535.
Workshops & Virtual Learning Sessions
- Meeting Your Goals for Preventing VTE: In-person workshop on March 11, 2011
- Virtual Learning Session 1: December 1, 2011
- Virtual Learning Session 2: January 17, 2012
- Virtual Learning Session 3: February 14, 2012
Additional resources for improvement
- Deltaparin versus Unfractionated Heparin in Critically Ill Patients
The PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group.
N Engl J Med 2011; 364:1305-1314
- e-VTE: A web based education resource designed to help raise awareness and improve understanding of Venous Thromboembolism
National Health Service. e-VTE: A web based education resource designed to help raise awareness and improve understanding of Venous Thromboembolism.
- Guideline on Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty
American Academy of Orthopaedic Surgeons. Guideline on Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty. Published by the American Academy of Orthopaedic Surgeons, Rosemont, IL. 2011.
- ISMP Develops Guidelines for Standard Order Sets
Institute for Safe Medication Practices. ISMP Develops Guidelines for Standard Order Sets. From Medication Safety Alert Newsletter. March 11, 2010.
- Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement
Maynard G., Stein J. Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. Prepared by the Society of Hospital Medicine. AHRQ Publication No. 08-0075. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. August 2008.
- Quick Reference Guide – Venous Thromboembolism: Reducing the Risk
National Institute for Health and Clinical Excellence. Quick Reference Guide – Venous Thromboembolism: Reducing the Risk. NICE Clinical Guideline 92. January 2010.
- Reducing the Risk of Thrombosis and Embolism During Pregnancy and the Puerperium
Royal College of Obstetricians and Gynaecologists. Reducing the Risk of Thrombosis and Embolism During Pregnancy and the Puerperium. Green-top Guideline No. 37. November 2009.
- Venous Thromboembolism Prevention: A Guide for Delivering the CQUIN Goal
Arya R., Hunt B. Venous Thromboembolism Prevention: A Guide for Delivering the CQUIN Goal. Published by the King’s Thrombosis Centre, Department of Haematological Medicine, UK. 2010.
- Venous Thromboembolism Safety Toolkit
University of Washington.
Resources and Tools Developed by Other Organizations
- VGH Critical Care Grand Rounds, May 14, 2013 – Dr. Deb Cook – Balancing Clotting and Bleeding in Med-Surg ICU Patients: Venous Thrombosis Prevention
- Patient Education Materials – BC Cancer Agency
- Sunnybrook Health Sciences Centre Thromboprophylaxis Policy
- Vancouver Coastal Health VTE Prevention Guideline: Thromboprophylaxis
- Vancouver Coastal Health Regional Thromboprophylaxis Policy
- Vancouver Coastal Health VTE Regional Risk Assessment and Prophylaxis Orders – Surgery