South Carolina Hospital Uses AHRQ Toolkit to Revise Protocol for Preventing Blood Clots

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, Carolina's Center for Medical Excellence, the QIO for South Carolina, worked with one hospital 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.

McLeod Medical Center in Dillon, South Carolina, entered the collaborative without a formal VTE risk assessment. Following participation, the hospital implemented the risk assessment presented in the learning session in its surgical and medical units. According to Joan Ervin, RN, CPHQ, Associate Administrator of Clinical Effectiveness, "Formal adoption and implementation of a VTE risk assessment improved our process. Now there is formal documentation as to why VTE prophylaxis has not been ordered, as opposed to thinking it was forgotten."

Policy changes led to an improvement in ordering appropriate VTE prophylaxis in both the surgical and medical patient populations. Compliance with ordering appropriate VTE prophylaxis in the surgical population improved from 88 to 92 percent. Similarly, compliance for ordering appropriate VTE prophylaxis in the medical population improved from 35 to 90 percent.

Loretta Lambert, RPh, Pharmacy Director, says, "McLeod benefited from participation in the AHRQ collaborative because the toolkit allowed us to quickly get up to speed on the issue and saved us a lot of additional work. Having Dr. Maynard available to clarify our questions and to help with physician communication was also very helpful."

Learning Network session activities were held in partnership with Carolina's Center for Medical Excellence. 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.