Indiana Hospitals Use AHRQ Tool to Revise Protocols for Preventing Venous Thromboembolism
Between January and September 2010, AHRQ partnered with seven Quality Improvement Organizations (QIOs) to deliver a series of onsite learning sessions and provider support calls for implementing the AHRQ-funded toolkit, Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. These events were part of a QIO Learning Network established through an AHRQ Knowledge Transfer project. As a result of this project, Health Care Excel, the QIO for Indiana, worked with four hospitals in the State to revise their VTE protocols.
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 developing VTEs.
St. Catherine's Hospital in East Chicago, Indiana, St. Mary Medical Center in Hobart, and Community Hospital in Munster—all part of Community Health Care System—entered the collaborative with a points-based risk assessment that did not clearly delineate risk categories. Following participation in the collaborative, Aileen Hrinda, RN, Quality Improvement Manager for St. Catherine's Hospital, reported that all three facilities now use a VTE risk assessment that differentiates among risk levels, connects risk levels to treatment, and requires reassessment when a patient's condition changes. Revised protocols were implemented in all units in the facilities between August and September 2010.
According to Sherry Brewer, RN, DNS, Director of Quality and Risk Management at St. Mary's Medical Center, there was a 15 percent increase in compliance with physicians' ordering of appropriate VTE prophylaxis after the revised protocol was implemented. Dianne Harrington, RN, Director of Quality and Risk at Community Hospital, says, "We did face some challenges in gaining acceptance of the VTE protocol form. Changes had to be made to satisfy both the wishes of the nursing and medical staff committee, while at the same time maintaining the concepts of the VTE toolkit. In the end, the risk assessment linked to treatment was approved."
Methodist Hospital in Gary, Indiana, collaborated with another health system to align and standardize the VTE protocol used in all facilities in the community. Merievelyn Stuber, Patient Safety Officer, Risk Management, reported that the previous points-based protocol led to errors, and appropriate VTE interventions were not consistently ordered. As a result of participating in the collaborative, the hospital adopted the risk-based protocol, which was integrated into its new electronic medical record system. The VTE risk assessment is completed upon admission and also when there is a change in condition and/or change in level of care.
Learning Network session activities were held in partnership with Health Care Excel. Gregory Maynard, MD, of the University of California, San Diego, developed the toolkit, and presented information during onsite learning sessions. He also provided expert support during technical assistance calls.