Patient Safety, 2012

Nebraska Hospitals Use AHRQ Toolkit to Revise Protocol for Preventing Hospital-Acquired Venous Thromboembolism (VTE)

May 2012

Twelve Nebraska critical access hospitals revised their protocol for preventing venous thromboembolism (VTE) after their State Quality Improvement Organization (QIO), CIMRO, participated in a series of onsite learning sessions and technical assistance calls for implementing the AHRQ toolkit Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement.

AHRQ's QIO Learning Network hosted the onsite sessions and calls between January and September 2011. Gregory Maynard, MD, of the University of California, San Diego, whose AHRQ-funded research provided the basis for the VTE prevention toolkit, presented information during the learning sessions and provided expert support during technical assistance calls.

The AHRQ toolkit is a comprehensive guide to help hospitals and clinicians implement processes to prevent dangerous blood clots. The 60-page guide details how to start, implement, evaluate, and sustain a quality improvement strategy. It includes case studies and forms that clinicians can use. The toolkit advises hospitals to establish a VTE prevention protocol for assessment of patients' risk for hospital-acquired VTEs and selection of the best method for preventing the condition.

The toolkit also encourages hospitals to discard a commonly used protocol that assigns points to risk factors for VTEs in order to determine the appropriate treatment option. Instead, the guide encourages hospitals to adopt a protocol that groups patients into three risk categories. Each category is associated with a clear set of recommendations about the most appropriate measures to prevent VTEs. The guide also advises hospitals to provide drug therapy to prevent clots to all patients at moderate or high risk of developing VTEs.

Before entering the project, Avera Creighton Hospital in Creighton, Nebraska, had a nurse-driven, points-based VTE risk assessment with varying degrees of physician use. After the 23-bed facility revised its protocol using the toolkit's guidance and implemented it throughout the hospital, appropriate VTE prophylaxis increased from 50 to 82 percent, and physician use of the revised protocol reached 91 percent from February through May 2011.

"The learning network helped the facility continue the work we had begun in preventing VTEs by giving us access to experts across the country who could answer questions and suggest best practices," says Jean Henes, RN, BSN, Director of Nursing. "We will continue to discuss VTE prevention with the medical and nursing staff until VTE prophylaxis is part of the standard of care at this facility."

Chadron Community Hospital in Chadron, Nebraska, entered the project with a paper-based, three-level VTE protocol that was used inconsistently. The 25-bed hospital revised the protocol using the toolkit's guidance and integrated it in the physician workflow within its newly implemented electronic health record (EHR). The EHR includes clinical alerts to integrate the VTE assessment and related prophylactic medication orders into the system. As a result of interventions, use of the VTE protocol increased from 47 to 54 percent from February through May 2011. After refining the assessment of a low-risk patient and increasing provider education, pharmacologic prophylaxis improved from 12 to 30 percent.

"Participation in this project created a wonderful opportunity for pharmacists, quality improvement staff, nurses, and our EHR vendor to work together to increase our providers' use of the VTE assessment tool and related pharmacological interventions," says Amy Hindman, RN, Quality Resource Manager. "Participation in the project encouraged us to place greater urgency on developing effective ways of having VTE prophylaxis addressed for all of our patients."

Memorial Hospital, a 25-bed facility in Aurora, Nebraska, used the toolkit to revise its complex, points-based risk assessment. As a result, prevalence of appropriate VTE prophylaxis improved from 65 to 100 percent between February and July 2011.

"Participation in the project provided excellent tools to educate the medical community about appropriate VTE risk assessment and treatment," says Cheryl Erickson, RN, Director of Nursing. "With this information, a simplified yet complete protocol was implemented, resulting in increased compliance that has improved patient safety and will continue to do so in the future."

Additional Nebraska hospitals that improved VTE prophylaxis from February through May 2011 after participating in onsite learning sessions and technical assistance calls include:

• Annie Jeffrey Memorial County Health Center in Osceola.
• Beatrice Community Hospital & Health Center in Beatrice.
• Community Hospital in McCook.
• Community Medical Center in Falls City.
• Crete Area Medical Center in Crete.
• Jefferson Community Health Center in Fairbury.
• Memorial Health Care Systems in Seward.
• Pender Community Hospital in Pender.
• Saunders Medical Center in Wahoo.

Knowledge Transfer Case Study Identifier: KT-CQuIPS-97
AHRQ Products: Partnerships in Implementing Patient Safety, QIO Learning Network
Topic(s): Hospital-Acquired Venous Thromboembolism
Scope: Nebraska

Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/vtguide/

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