DVT Prophylaxis Suzie Feuling ProHealth Care Waukesha, Wisconsin

Objectives  Discuss risk of DVT in Stroke  Discuss common DVT Prevention  Discuss the Joint Commission Primary Stroke Center DVT Prophylaxis Metric

DVT – Hospitalized Patients are at Risk in General General Risk Factors Age over 65 years Obesity Smoker Birth Control / HRT Orthopedic Arthroscopy, Gyn Laparoscopic surgery, Vascular surgery, Major Neurologic surgery, Spine Surgery Dehydration

High Risk for DVT Active COPD Active Heart Failure Ambulation out of the room less than 4 times per day Pregnant (not in labor) Non weight bearing on admit Bedrest order Highest Risk for DVT Previous DVT BR >72 hours NWB >72 hours Spinal Cord injury Sepsis/Severe Infection Readmit within 30 days of major surgery Major Orthopedic Surgery of lower limbs Major open urologic, abdominal or GYN surgery Cancer Diagnosis Current Multiple Trauma Hip Fracture

DVT – Stroke Patients are at Risk  Studies show that up to 1/3 of patients with moderately severe stroke developed proximal DVT The Joint Commission Stroke Performance Measurement Implementation Guide 2 nd Edition: Section 4

Prevention of DVT  Movement  Sequential Compression Devices  Pharmacologic treatment Anticoagulation  Not on the list: Teds…&…Aspirin

Understanding the JC DVT Prophylaxis Metric  Ischemic or Hemorrhagic Stroke  Elective Carotid Endart is excluded  Patient is nonambulatory at the end of hospital day 2. Look at the activity documented. Is the patient walking in the halls?  If DVT Prophylaxis is indicated, it must be documented by the end of hospital day 2. Admit date is day 1 – this can be tricky The Joint Commission Stroke Performance Measurement Implementation Guide 2 nd Edition: Section 4

Get With the Guidelines Data PSC Stroke 1- DVT Prophylaxis PSC Stroke-1* Benchmark GroupTime PeriodNumeratorDenominator% of Patients All Hospitals01/01/ /30/ % East North Central Hospitals01/01/ /30/ % Midwest Region Hospitals01/01/ /30/ %

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