Minnesota Hospital Association

Quality & Patient Safety

Venous Thromboembolism

Each year, there are more than 30 million surgeries performed in the U.S. and venous thromboembolisms (blood clots) are one of the most common postoperative complications. While postoperative venous thromboembolisms (VTE) are considered a hospital-acquired condition, they can often be prevented by following a few evidence-based guidelines.

VTEs include deep vein thromboses (DVT), blood clots that form in a vein deep in the body most often in the leg or thigh, and pulmonary embolisms (PE), blood clots that travel to the lungs and block blood flow. The frequency of VTE is related to the type and duration of surgery, patient risk factors, duration and extent of postoperative immobilization, and use or non-use of prophylaxis such as compression sleeves or mechanical devices.   

Download the VTE Prevention Strategies gap analysis, which is a component of the Medication Safety road map.

VTE toolkit

The tool kit provides best practices that hospitals can use to implement the VTE Prevention Strategies Gap Analysis in their facilities. This gap analysis is a component of the MHA Road Map to a Medication Safety Program.

"Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement" (Society of Hospital Medicine). This comprehensive site includes information from the Society of Hospital Medicine on effective quality improvement techniques for VTE prevention.
“Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement” (U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality [AHRQ]). Based on quality improvement initiatives undertaken at the University of California, San Diego Medical Center, and Emory University Hospitals, this guide helps quality improvement practitioners to improve prevention of one of the most important problems facing hospitalized patients: hospital-acquired VTE.
“Blood Clot Education for Patients & Professionals” (National Blood Clot Alliance: Stop the Clot®). This organization is dedicated to DVT/PE prevention. It includes blood clot education for patients and professionals, links to news articles, and various events.
“ACCP Evidence-Based Clinical Practice Guidelines and Consensus Statements” (Chest, American College of Chest Physicians). This site includes links to ACCP evidence-based clinical practice guidelines and consensus statements.
Map of Medicine®: Venous Thromboembolism (VTE) Risk Assessment (All Patients)” (National Health Service [NHS]). The site includes a VTE risk assessment algorithm.
“NICE Pathways: Venous Thromboembolism Overview” (NHS, National Institute for Health and Clinical Excellence [NICE]). An interactive tool for providing guidance and associated products for VTE prevention.
“Venous Thromboembolus (VTE): Mentor Hospital Registry” (Institute for Healthcare Improvement [IHI]). A listing of IHI Mentor Hospitals for VTE treatment and prevention.
“Expedition for Hospitals: Preventing  Venous Thromboembolism (VTE). Offered by IHI at a cost and allows hospitals to access information that will help them to implement a program to prevent VTE.
“Venous Thromboembolism (VTE) Prevention in the Hospital” (AHRQ). Site includes a link to Dr. Greg Maynard’s slide presentation on VTE prevention.
VTE prophylaxis flowchart, from Health Education and Management Innovations, Australia
Prevention of venous thromboembolism after surgery, from Cleveland Clinic Journal of Medicine.
"Venous Thromboembolism and Prophylaxis in the Surgical Patient", a SCIP Quality Measures learning module.

Articles:
Using a framework for spread of best practices to implement successful venous thromboembolism prophylaxis throughout a large hospital system.” Morgenthaler, Timothy et al. Spreading VTE prevention best practices in a large hospital system.

 “ACOG Issues Guidelines to Prevent Thromboembolic Events.” by Barclay, Laurie. A Medscape article discussing ACOG issues guidelines to prevent thromboembolic events.

At Lakeview Hospital teamwork and collaboration lead to better outcomes for patients

Each year, there are more than 30 million surgeries performed in the U.S., and venous thromboembolisms (blood clots) are one of the most common postoperative complications. While postsurgical venous thromboembolisms (VTE) are considered a hospital acquired condition, most can be prevented by following a few evidence-based guidelines.  

In alignment with the recommended strategies to prevent VTE, staff at Lakeview Hospital in Stillwater regularly ordered postoperative mechanical and pharmacological treatments for surgical patients, but the approaches were inconsistent across hospital units. With the mantra to do “what’s best for the patient,” Lakeview Hospital staff set out to standardize its approach to VTE prevention.   

To successfully tackle the change, Lakeview focused on three areas: hospital culture, leadership and standardization. Change can be a difficult pill to swallow and quality improvement leaders knew it would be critical to get buy-in from physician leaders and hospital administration. By reviewing literature and implementing best practices through teamwork and collaboration, Lakeview was able to update approximately 20 pre-printed order sets to reflect CMS guidelines and ensure a standardized approach to provide patients with safe, effective and timely patient-centered care.  

After a thorough needs analysis from the different units and a review of the literature for the effectiveness of the different mechanical devices available to prevent VTE, a standard device was selected to use across units. The new mechanical devices are quieter and easier to put on, improving both patient and nurse satisfaction. Lakeview’s patient satisfaction scores consistently average in the 95th percentile. Furthermore, after implementation of the change, the hospital has achieved 100 percent compliance with national quality standards. And the icing on the cake: in 2011, Lakeview realized savings of $45,000 by standardizing mechanical devices.  

“It took collaboration and for everyone to be involved for this project to be successful,” said Cindy Appleseth, RPh, director of pharmacy. “And our patients are the ultimate winners!”