1. Venous Thromboembolism (VTE) Prophylaxis Policy Mary-Anne Davies Patient Safety Specialist Accreditation Coordinator

2. 1 What is VTE?  VTE is Venous Thromboembolism  Includes deep vein thrombosis (DVT) and pulmonary embolism (PE)  DVT is a blood clot that forms in the deep vein in the leg  PE is a clot that has broken off and traveled to the lungs DVT +/- PE = VTE

3. 2 Why is VTE Important?  VTE is one of most common and preventable complications of hospitalization  The rate of hospital-acquired VTE is 10 - 40% after general surgery and 40 - 60% after hip surgery if thromboprophylaxis is not used  DVT or PE is associated with increased mortality, increased length of stay  Accreditation Canada has made VTE Prophylaxis a Required Organizational Practice (ROP)

4. 3 How Do We Meet the ROP?  Written thromboprophylaxis policy or guideline  Identify patients at risk for VTE and provide appropriate prophylaxis  Audit compliance and use of thromboprophylaxis  Identify major orthopaedic surgery patients requiring post-discharge prophylaxis and provide to them  Provide information to health professionals and patients about risks and prevention 3

5. 4 VTE Prophylaxis Policy  LHSC assesses all patients for the risk of VTE using the Identification of Patients at Risk for VTE (Appendix A) upon:  admission to hospital  a significant change* in clinical status  any Transition Point in care, including discharge Examples include change in activity status – ambulatory to bedrest; becoming more acutely ill; decrease in bleeding risk. https://apps.lhsc.on.ca/lhsc-policy/search_res.php?polid=PCC075&live=1 4

6. 5 Risk Assessment – Appendix A 5

7. 6 Decision Tree for Venous Thromboembolism Prophylaxis (VTE)  Decision tree can be launched from the VTE module and can also be found on the VTE website Decision tree 6

8. 7 Risk Assessment – Who and When  Conducted by the Most Responsible Professional (MRP)/delegate at:  time of admission  discharge.  Conducted by the MRP/delegate OR another member of the health care team (HCT):  throughout hospital admission – transitions in care and changes in clinical status 7

9. 8 Appropriate Prophylaxis  Pharmacological prophylaxis  Low molecular weight heparin (LMWH)  Low dose unfractionated heparin  Other anticoagulant  Mechanical prophylaxis  For patients with high risk of bleeding  Intermittent Pneumatic Compression (IPC) devices with or without Anti-embolic stockings (TEDs) 8

10. 9 Steps for Determining VTE Prophylaxis Venous thromboembolism prophylaxis is a three step process which includes: 1. Determining if VTE prophylaxis is required (guidelines provided in Appendix A). 2. Determining if VTE prophylaxis is contraindicated, considering both pharmacological and mechanical prophylaxis options, where applicable (guidelines provided in Appendix A) 3. Determining and providing the appropriate prophylaxis for eligible patients. (guidelines provided in Appendix B or C) 9

11. 10 How to Order  On admission and at transition points use the VTE Module 10

12. 11 How to Order 11 Risk assessment Appropriate Prophylaxis

13. 12 Patient Education  Important to educate patients on their risk and how to prevent VTE  Pamphlet available and can be accessed through website Pamphlet 12

14. 13 Staff Resources  Website http://www.lhsc.on.ca/priv/VTE/http://www.lhsc.on.ca/priv/VTE/  Staff presentations  Poster Poster 13

15. 14Questions? Mary-Anne Davies – ext. 52280 or email maryanne.davies@lhsc.on.ca maryanne.davies@lhsc.on.ca 14