KEY LESSONS: Clinical Decision Support for Venous Thromboembolism (VTE) Prevention

 

[Follows outlines of new CDS implementer's guide to help support scaling to other topics; most of the key guidance is currently in the Examine Workflow and Optimize CDS Interventions headers, but be sure to review Consider CDS Basics]

 

Click here for case studies of CDS applied successfully to VTE prevention

 

 

• Consider CDS Basics

  • Project Abstract 

  • Define CDS broadly

  • Consider CDS 5 Rights A worksheet describing the different workflow steps and how to achieve the 5 CDS rights. Describes at a high level the different CDS interventions that could be made available at each workflow step

• Establish the Foundation

  • Engage all pertinent stakeholders and establish governance

  • Select and prioritize targets; align with organizational imperatives

  • Establish baselines

• Examine the Workflow

  • Study, observe, and document the clinical workflow: Overall Approach to Workflow Mapping

  • High level workflow for VTE

  • More detailed VTE workflows

    • In organizations where VTE risk assessment is Physician driven

    • In organizations where VTE risk assessment is Nursing driven

 

• Optimize CDS Interventions for Specific Targets: VTE

 

[In this section are the specific considerations for successfully incorporating CDS into various workflow steps for improving appropriate VTE prophylaxis. Note that this VTE-specific information is layered onto more generic backbone tables that include general CDS considerations for each workflow step. Please help us flesh out the CDS 'implementation pearls' specific to VTE! (Enhancements to generic backbone welcome too!)]

 

• Leverage deployments/goals

• Think beyond CPOE/EHR in the acute setting; consider patient portal

• Utilize workflow analysis to satisfy CDS 5 rights and avoid alert fatigue

  • Before Care Episode

    • Organization

    • Patient

  • During Encounter: Applying CDS to Support Specific Targets -

    • Patient risk stratification (sample approaches from participating sites)
    • Nursing documentation/order entry
    • Physician & Patient/H&P and Plan 
    • Physician order entry and pharmacist role 
    • CDS Mapping for VTE
  • After Encounter  

• Deploy CDS for Maximum Acceptance and Value

  • Partner with users in CDS implementation

  • Continue to leverage governance established in Foundation step

• Measure Effects and Refine CDS Program

  • Examine both intended and unintended effects and continuously enhance the CDS program

  • Link assessment to organizational priorities and reporting

  • Donabedian framework

• Manage Knowledge Assets and Processes

  • Approach proactively and systematically

 

• Recent Collaboration Discussion with IHI/SHM
  • Discussion Thread on collaboration between HIMSS, IHI, SHM

 

• Questions and Discussion Forum