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Siraj (10-20-09):
VTE Metrics: What type of metrics should one use to identify how the organization is doing? What metrics define improvement in quality that is specific to VTE?
Siraj (10-20-09):
Prophylaxis rates/1000 patients
% of documented VTE risk assessments
% of Pharmacological Prophylaxis
% of Mechanical Prophylaxis
VTE incidence rates/1000 hospital days
# of VTE incidences when not on appropriate prophylaxis
VTE risk assesment tool completion rates/individual physician
Kendall Rogers (10-22-09):
'Appropriate' VTE prophylaxis rate (no prophylaxis, some prophylaxis, appropriate prophylaxis for risk level, or contraindication)
VTE incidence rate per 1000 hospital days
Preventable VTE incidence rate per 1000 hospital days (number of VTE incidence when not on appropriate prophylaxis)
Utilization rate of screening and order entry tool at admission and transfer
Greg Maynard 11-05-09
All the metrics others have listed above can be useful. Some, like gauging appropriate prophylaxis, require a fairly labor chart review, to assess level of VTE risk and the absence or presence of contraindications to anticoagulants.
While less granular, a more practical method and one more amenable to automation and tracking, is the simple categorization of patients as Red, Yellow, or Green, as described below:
The medication administration record (MAR) or an automated report (often generated by pharmacy) is presented to front line staff, identifying the VTE prophylaxis status of each patient on the ward. Advanced versions of this approach have actually classified each patient on the ward as being “green” (an order in place for therapeutic or prophylactic anticoagulation), the “yellow” (mechanical prophylaxis without pharmacologic prophylaxis), or “red” (no VTE prophylaxis orderd). Extracting this information from the MAR into a report creates a situational awareness, calling for explicit action on the part of the front line staff member.
The staff member (usually a staff nurse or charge nurse, but sometimes a pharmacist) is then called upon to intervene on patients that seem to be non-adherent to the protocol. For example, if a patient is classified as red, nursing can be authorized to place sequential compression devices on the patient - and if there are no obvious bleeding problems and any VTE risk factor is present – can place a simple templated note on the chart and text page the physician, asking them to either place the patient on pharmacologic prophylaxis or state the reason they choose not to do this. This method can quickly bolster VTE prophylaxis rates to 95% , and fatigue from alerts can be minimized if the intervention part of the strategy is deployed after the order set is launched.
This method is therefore useful for measurement, but also useful for spurring real time intervention....that's why we call this method "measure-vention".
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