Iowa Hospitals Use AHRQ Toolkit to Improve Practices for Patients at Risk for Blood Clots
Between September 2008 and May 2009, AHRQ hosted a series of seven Web conferences about its toolkit, Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. These events were part of an AHRQ Knowledge Transfer project. As a result of the Web conference series, two hospitals in Iowa changed their policies on caring for patients at risk for venous thromboembolism (VTE).
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, as well as forms that clinicians can use. The toolkit advises hospitals to establish VTE prevention protocols to assess patients' risk for hospital-acquired VTEs and select the best method for preventing the condition.
The toolkit encourages hospitals to discard commonly used protocols that assign points to risk factors for VTEs in order to determine the appropriate treatment option. Instead, the guide encourages hospitals to adopt protocols that group 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 VTEs.
According to Marcia Kruse, RN, Director of Case Management, Fort Madison Community Hospital in Fort Madison, Iowa, replaced a complicated points-based protocol with a risk-based protocol that provides clearer guidance about recommended forms of VTE prevention and contraindications. The hospital shifted from measuring VTE prevention rates on a quarterly basis to a monthly measure. As a result of these changes, the hospital has experienced an improvement in VTE prevention rates—from 79 percent in May 2009 to 96 percent in September 2009.
Mahaska Health Partnership in Oskaloosa, Iowa, discarded a points-based protocol that was being piloted at the beginning of the Web conferences. Instead, it developed a protocol that assigns patients into one of three risk groups. Dawn Voss, RN, BSN, Mahaska's Director of Clinical Quality, says, "The Web conferences and the AHRQ toolkit have been so helpful. This system is going to be much easier for our physicians to use."
The Web conferences were held in partnership with the Iowa Foundation for Medical Care, Iowa's Quality Improvement Organization. Gregory Maynard, MD, of the University of California, San Diego, developed the toolkit and presented information during the conferences.