Are your patients receiving appropriate thromboprophylaxis 100 per cent of the time?

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Meet Mary. She is a 61-year-old working artist who, apart from leg pain and limitations due to osteoarthritis of her hips and knees, is considered to be healthy.

After years of progressive pain, Mary decided to undergo knee arthroplasty. Despite her positive attitude going into surgery, Mary developed major bilateral pulmonary emboli a few days after she was discharged from hospital. A pulmonary embolism is when an abnormal blood clot (thrombosis) forms inside a vein deep in the leg, causing leg pain and swelling. A blood clot in a leg vein can grow, break off, and travel to the lungs, resulting in shortness of breath, chest pain, and in some cases, death.

Venous thromoboembolism (VTE), which comprises both deep vein thrombosis and pulmonary embolism, is one of the most common and preventable complications of hospitalization. Almost every hospitalized patient has at least one of the risk factors for VTE and most have multiple risk factors.

Mary’s marked shortness of breath and chest pain slowly resolved over several weeks after starting anticoagulant therapy. However, she felt alone in trying to understand the cause of her distressing symptoms and why better thromboprophylaxis had not been used in her case. She is now reluctant to have more surgery because of her near fatal event.

Mary hopes that healthcare providers will take serious “steps towards a healthier and safer public environment” by understanding the risks for deep vein thrombosis and pulmonary embolism and providing appropriate thromboprophylaxis for patients who are at risk.

Every year in Canada, thousands of people go through procedures just like Mary. The rate of hospital-acquired VTE, if a thromboprophylaxis is not used, is 10–40 per cent after general surgery and 40–60 per cent after major orthopedic surgery.

According to an evidence report prepared for the Agency for Healthcare Research and Quality in the United States, the appropriate use of thromboprophylaxis was the most highly rated of 79 safety practices based on its impact and effectiveness and was, therefore, considered to be the number one ranked patient safety practice for hospitals.

At your hospital, do 100 per cent of hospital patients at risk for VTE receive appropriate thromboprophylaxis 100 per cent of the time?

If not, you’ve definitely got some work to do. But don’t worry, you’re not alone and we can help.

Canadian VTE Audit Day was held on April 10 to establish a national perspective of thromboprophylaxis rates and to raise awareness about this key patient safety strategy.

We were thrilled to see 118 organizations submitted data on VTE thromboprophylaxis rates for 4,667 patients. Overall, the data indicates that 81 per cent of patients did receive appropriate thromboprophylaxis. This generally represents good news but, since 19 per cent of the patients at risk did not receive appropriate thromboprophylaxis, the national audit also demonstrates that there is definitely room for improvement.

In addition to the acute consequences of hospital-acquired VTE, there are also important long-term complications to consider. For instance, both deep vein thrombosis and pulmonary embolism require anticoagulation for at least several months and patients who develop VTE are more likely to have recurrent thromboembolic events in the future. These and other complications represent substantial costs in terms of patient quality of life and healthcare resources.

To assist organizations in ensuring their patients are receiving appropriate thromboprophylaxis 100 per cent of the time, Safer Healthcare Now! offers a free Getting Started Kit on VTE in both French and English to help engage interprofessional and interdisciplinary teams in a dynamic approach for improving quality and safety. The Getting Started Kit for VTE, which was last updated and published in May 2012, represents the most current evidence, knowledge and practice, as of the date of publication. Patient Safety Metrics, an online measurement and data collection tool, is also available to assist teams with their auditing and improvement efforts.

Along with the Getting Started Kit and Patient Safety Metrics, Safer Healthcare Now! provides access to a number of supports and resources to assist local teams in improving patient safety and quality.

For the sake of Mary and the thousands like her, visit www.saferhealthcarenow.ca to learn more about VTE and how your organization can be a leader in the use of appropriate thromboprophylaxis.