1. DVT Prophylaxis Suzie Feuling ProHealth Care Waukesha, Wisconsin

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

3. 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

4. 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

5. 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

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

7. 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

8. Get With the Guidelines Data PSC Stroke 1- DVT Prophylaxis PSC Stroke-1* Benchmark GroupTime PeriodNumeratorDenominator% of Patients All Hospitals01/01/2008 - 09/30/2008625706830391.6% East North Central Hospitals01/01/2008 - 09/30/20087899859691.9% Midwest Region Hospitals01/01/2008 - 09/30/2008117301279891.7%

9. Contact Info Suzie Feuling (262) 928-3438 suzanne.feuling@phci.org