The Queensway Carleton Hospital has created a tool that is quite unique and very successful in increasing the use of thromboprophylaxis. Dr. Shelita Dattani, Clinical Coordinator of Pharmacy Services and lead of the Venous Thromboembolism (VTE) Prophylaxis Project, Queensway Carleton Hospital says that while the standard in most hospitals is to administer VTE prophylaxis within the first 24 hours, the hospital set up a protocol to administer the appropriate VTE prophylaxis within the first few hours of admission, unless there is a contraindication.
“We created an admission order that starts in Emergency that was developed mostly for medical patients, but addressed VTE prophylaxis for all patients that come in through the door and are admitted,” says Dattani. “We are able to catch those patients that typically fall through the cracks and implement an automatic patient assessment on a daily basis, if for some reason the prophylaxis is not ordered on admission.”
To help finesse their best practices and get ready for the required organizational practice in an upcoming Accreditation Canada survey, Queensway Carleton Hospital joined the Venous Thromboembolism Collaborative STOP THE CLOT. “It was interesting to hear about the approaches to prevent venous thromboembolism that teams have taken and to share our experiences,” says Dattani. “Being able to talk to key leaders and having them share their expertise and wealth of knowledge has been invaluable.”
The Queensway Carleton VTE protocol was supported by a targeted awareness campaign. Physicians were provided with pens embossed with the STOP THE CLOT logo, reminding them to think about VTE prophylaxis when they were writing orders for patients. Posters displayed throughout the hospital highlighted a photo of the multi-disciplinary team, working together to prevent blood clots. The poster reinforces that this was a collaborative effort and it is the entire healthcare circle that is advocating for the patient.
Stickers were adhered to identification badges, saying NO VTE, STOP THE CLOT, prompting patients to ask, ‘what does that mean’? “We tell our patients that although blood clots are rare they can be fatal, and explain how the team is working together to prevent them by giving anticoagulant medications in hospital,” says Dattani. “Patients have comfort in hearing that.”
Dattani says they knew from previous experience that the use of pre-printed orders helped enforce compliance with VTE prophylaxis: “Within a couple of weeks of implementing preprinted orders, our compliance rates topped over 90 per cent and we have been able to sustain that level. We will be re-measuring our sustainability, but the real question we need to answer is: are we actually preventing blood clots?” The Queensway Carlton Hospital is also looking at other measures, such as the number of patients arriving in the emergency with a deep vein thrombosis (DVT) and balancing measures to determine if there are any increases in bleeding rates.
For more information on preventing venous thromboembolism, visit www.saferhealthcarenow.ca