after reading this learning module, the nurse should be able to · 2020-04-08 · core vte-3 - vte...
TRANSCRIPT
After reading this learning module, the
nurse should be able to:
• Identify the VTE dashboard and understand how
to initiate it
• Identify the requirements of the VTE Core
Measure and the nurse‟s responsibilities for each
VTE (A DVT or PE) is the most common PREVENTABLE
serious complication in the hospital and the second
most common cause of increase length of stay.
10% of hospital deaths are attributed to PE, PE is the
most preventable cause death.
About 350,000 to 600,000 cases of DVT and pulmonary
embolism (PE) are reported annually.
200,000 deaths occur from DVT/PE which is more than
AIDS and breast cancer combined.
VTE is the newest Core Measure
Requires VTE prophylaxis to be addressed
on ALL in-patients.
Pharmacological prophylaxis, mechanical
prophylaxis, or a contraindication to
prophylaxis must be documented on the day of
admission or the day after admission.
Much room for improvement
Goal is 100%
Apr 2012 May 2012 Jun 2012 Jul 2012 Aug 2012 Sep 2012 Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013
Core VTE-1 - Venous Thromboembolism Prophylaxis 87.097 94.444 97.222 87.879 96.97 88.889 88.889 85.714 96.97 87.5 88.462
Core VTE-2 - ICU Venous Thromboembolism Prophylaxis 100 100 100 93.333 100 77.778 100 87.5 100 91.667 100
Core VTE-3 - VTE Patients With Anticoag Overlap Therapy 100 100 100 96.552 96.296 80.952 83.333 95.455 84.848 95.833 89.286
Core VTE-4 - VTE Pts Receiving UFH with Dosage/Platelet Monitoring 58.824 44.444 65.385 44.444 51.613 42.857 39.13 58.621 57.143 62.069 44
Core VTE-5 - VTE Warfarin Therapy Discharge Instructions 86.667 100 94.118 91.667 83.333 89.474 100 92.857 90 86.667 89.474
Core VTE-6 - Hospital Acquired Potentially-Preventable VTE 0 0 0 0 33.333 16.667 40 50 0 10 0
Core VTE ALL All-or-None Bundle 80 80.328 84.932 70.513 74.667 69.565 72.727 73.973 76.19 75.641 70.968
Current best practice - nursing should perform
a VTE risk assessment.
The VTE risk assessment is required for all
adult inpatients.
Completion of VTE risk assessment is required
for:
• All adult inpatients at time of admission
• All patients transferred into an ICU
• All patients who under go a procedure requiring
general anesthesia
Admitting nurse
should check ALL
fields that apply to
patient
The score will
automatically
populate to the box
Locate the
“suggested plan”
under ORDERS
and initiate
the plan.
If no suggested
plan exists, order
one
and initiate it
Nursing
Responsibility
The goal of the CDI nurses is to identify
patients who have a VTE and establish if
it is present on admission and make sure
that it is documented appropriately.
The CDI nurses use the physician
documentation to assist in coding
appropriately. Nursing documentation is
used to correlate physician findings.
1-VTE Prophylaxis
2-ICU VTE
3-VTE Patients with Anticoagulation Overlap Therapy
4-VTE Patients Receiving Unfractionated Heparin with
Dosages/Platelet Count Monitoring by Protocol
5-VTE Warfarin Therapy Discharge Instructions
6-Hospital Acquired Potentially –Preventable VTE
The day of or the day after hospital admission
patients must receive VTE Prophylaxis or have
a documented reason why no VTE was given
Nursing Responsibility:
• Ensure every patient has prophylaxis ordered and it is initiated.
Examples of prophylaxis are heparin, Lovenox, or SCDs. Medications
must be ADMINISTERED and SCDs must be documented as being
APPLIED.
• If no prophylaxis is ordered and no reason is documented why there is
no prophylaxis, call physician for order.
The day of or the day after ICU admission (or
transfer) patients must receive VTE prophylaxis
or have a documented reason why no VTE was
given
Nursing Responsibility:
• That every patient has prophylaxis ordered and it is initiated.
Examples of prophylaxis are heparin, Lovenox, or SCDs. Medications
must be ADMINISTERED and SCDs must be documented as being
APPLIED.
• If no prophylaxis is ordered and no reason is documented why there
is no prophylaxis, call physician for order.
• Completion required for ALL patient admitted to ICUs and
transferred into ICUs.
For all patients who are diagnosed with a VTE and
receive an overlap of parenteral (IV or Subcu)
anticoagulation and warfarin
• Overlap therapy should be administered for at least 5 days with
an INR > or = 2 prior to discontinuation of anticoagulation
• Patients who receive < 5 days of overlap therapy should be
discharged on both medications or have a reason documented
for Discontinuation of Parenteral Therapy
Patient‟s with a diagnosed VTE who receive IV
UFH therapy must have their therapy dosages
AND platelet counts monitored according to
the Heparin by Weight Protocol
Nursing Responsibility:
• Ensure that ALL patients with IV UFH (Weight Based Heparin)
have the Weight Based Heparin Protocol ordered.
• Ensure that the DAILY CBC that is part of this protocol is NOT
discontinued if additional CBCs are ordered.
Patients with a diagnosed VTE discharged to home,
with home care, court/law enforcement or home
hospice must be given written instructions containing
4 key elements • Compliance
• Dietary documentation
• Information about plans to monitor warfarin after discharge
• Information on adverse drug/food reactions
Nursing Responsibility:
• Ensure that every patient going home on warfarin (Coumadin) receives the
Warfarin Education Discharge Instructions.
• These instructions include all four components required for the VTE Core
Measure and are found on the intranet (see following slides).
• This education should be completed during the entire patient stay, not just
at discharge.
1. Access Aultman
Intranet
2. Click on „Tools”
3. Click on Policy and
Procedures
4. Type “Patient
Education: Treatment
with Warfarin” in the
“Search for box”
5. Click on this and print
1. Compliance must address: The importance of taking warfarin as instructed AND
The importance of monitoring warfarin with scheduled PT/INR blood
draws
2. Dietary Documentation must instruct the
patient all of the following: • A “consistent amount" of foods with Vitamin K rather than avoidance
should be advised
• Avoid major changes in dietary habits, or notify health professional
before changing habits
3. Follow-up must include information about
plans to monitor warfarin after discharge
4. Information on adverse drug/food reactions
must contain the following:
• Diet and medications can affect the PT/INR level
• Do not take or D/C any medications or over-the-
counter medications without advice from a
physician/pharmacist
• Warfarin increases the risk of bleeding
• Nursing documentation for the Warfarin Discharge Instructions must be
done on the “Warfarin (Coumadin) powerform.
• All four boxes must be checked complete to meet the requirements.
• This form fires ONE time only when the med is ordered.
