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Venous Thromboembolism (VTE)

Venous thromboembolism or VTE, describes two related conditions: deep vein thrombosis (DVT) and a more serious complication called pulmonary embolism (PE). Both conditions are blood clots in the vascular system. These blood clots often form in the legs. Pieces of these leg clots can break off and travel to the lungs causing a serious condition called pulmonary embolism.

The risks for developing blood clots in the legs and lung include immobility such as being sick in bed, surgery, and certain medical conditions. For this reason, we take steps to prevent these blood clots from forming.

The nurses at JFK evaluate every inpatient for their risk of developing VTE on admission and daily thereafter. Nursing notifies the physician when a patient is a high risk for developing a VTE and prophylaxis is not ordered. The physician may order medications known as anticoagulants (sometimes called blood thinners), or compression stocking with pumps for the legs (an air pump machine connected to a disposable sleeve squeezes the leg intermittently improving blood return). Preventing VTE is the major reason that hospitalized patients are encouraged to be up and walking as soon as possible after surgery.

What are we measuring?

1. VTE prevention

We are measuring how well we provide VTE prevention, which is medication and/or compression stockings by hospital day two (2).

2016Q4 VTE 1

 

What does the VTE Prevention graph tell us about our performance?

The graph shows that over time an increasing percentage of patients are receiving VTE prophylaxis by the day after admission.

In 2013, Centers for Medicare and Medicaid in 2013 introduced a measure for VTE prevention. Nurses then began a process to evaluate every patient for their risk of VTE on admission and each day thereafter. Nursing notifies the physician when a patient’s risk for developing VTE is high and prophylaxis is not ordered. In addition, there are reminders for physicians and nurses to assess the risk and order prophylaxis when needed. These practices have resulted in significantly more patients receiving VTE prevention the day of or the day after admission. 

2. Potentially Preventable VTE Graph

This graph shows the number of hospital patients who did not have either medication or compression stocking ordered and developed a VTE while in the hospital. While VTE is not always preventable, research tells us that VTE prevention - medication and/or compression stockings - can help avoid VTE. 

We have multiple processes in place to see that all patients who are candidates receive prevention. Nursing evaluates every patient’s risk of developing a VTE and notifies the physician about patients who are high risk and do not have prevention in place. It is our goal to provide VTE prevention to all patients at the time it is indicated. 

                         

2016Q4 VTE 2

What does the VTE Prevention graph tell us about our performance?

TThis graph shows that over time fewer patients who developed VTE did not receive prevention. From January 2015 through June 2016, there were no patients with developed VTE and did not receive prevention. However, in the last half of 2016 two patients who did not receive prevention developed VTE. These cases were reviewed in depth.

We are pleased that our processes to identify and administer VTE prevention to patients who need it have decreased potentially preventable VTEs. However, it is our goal to provide prevention to every patient when indicated. We take the risk of VTE seriously and continue to work to provide proper VTE prevention every time to every patient.

What can you do to prevent VTE?

While you are in the hospital:

  • Know your medication. Tell your nurse and your physician about all the medications you are taking.
  • Know your health history.  Tell the nursing staff as well as your physician about any history of DVT or Pulmonary Embolism.
  • If compression pumps are ordered for you, wear them. Ask the nursing staff for assistance when you get out of bed.

While you are home:

  • Stay active. Walking helps with blood circulation and with weight loss.
  • STOP smoking.
  • Maintain a normal body weight and eat a healthy diet.
  • Discuss risks of birth control or hormone replacement therapy with your health care provider.
  • If you are hospitalized for any medical or surgical condition, ask the doctor what he or she is planning to do to decrease your risks of DVTs and PEs.
  • Find out if there is any family history of VTE or abnormal blood clotting. If so, discuss any tests or steps you should take with your health care provider.
  • If you take long airline or auto trips, get up and walk every hour or so, and tighten the calf muscles by flexing your foot and raising your toes 10-15 times each hour. Additionally, avoid alcohol and drink plenty of fluids.
  • Follow your health care provider’s instructions to keep any medical conditions under best control.

Follow the sites below for additional information about preventing VTE: