Washington State 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, Qualis Health, the QIO for Washington, 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.
Yakima Valley Memorial Hospital in Yakima, Washington, implemented the toolkit in August 2010 and made it available to all medical and surgical units. As a result of this change, appropriate VTE prophylaxis orders increased from 70 to 83 percent in a sample of medical patients. Over a 9-month period, there was a significant increase in appropriate prophylaxis ordering in the surgical patient population-from 93 to 100 percent. Additionally, the rate of receipt of appropriate prophylaxis increased from 90 to 97 percent in surgical patients.
According to Mely Acob-Davenport, RN, MBA, Director of Performance Improvement, "Following participation in the learning collaborative, we identified that our stand-alone, point-based VTE prophylaxis protocol was too complicated and cumbersome, so we developed and implemented a new protocol based on the examples provided in the toolkit."
The concept of "measure-vention"—a strategy for monitoring for VTE risk in real time that empowers hospital staff to remedy issues in real time—was introduced to participants of the Learning Network. As a result of this training, the information technology pharmacist at Yakima Valley Memorial developed an electronic method for identifying patients that do not have active orders for VTE prophylaxis. A clinical pharmacist's daily work list now includes patients without orders for anticoagulants or sequential compression devices, which improved the efficiency of screening patients for effective prophylaxis. Acob-Davenport says, "Collaboration among hospitals facilitates rapid results in the journey to excellence, as we share insights and build upon one another's momentum for change."
Learning Network session activities were held in partnership with Qualis Health. 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.