1. VTE Prevention in Labor & Delivery and Women’s Health

2. Dr. Gianopoulos Dr. Besinger Dr. Carroll Dr. Brubaker Dr. Fitzgerald Maureen Davey, RN Peggy Downing, RN Sandy Swanson, RN LuAnn Vis, RN Team Members:

3. Plan: Implement and Utilize a VTE Prevention Protocol in Obstetrical, Gynecology and UroGynecology surgery patients in the Labor and Delivery and Women’s Health areas.

4. Measure: 100% compliance with VTE prophylaxis protocol Long term goal to decrease VTE rate in patient populations.

5. Solutions Implemented January’06: Developed & conducted a SCD use survey completed by RN’s on all patient’s undergoing abdominal or pelvic surgery in the L&D operating rooms Education of all RN’s on the importance of VTE prophylaxis SCD’s were added to the stock in the L&D pre-op holding area July ’06: Added heparin administration to data questionnaire December ’06: Assess utilization of SCD until patient ambulating.

6. Labor & Delivery QI Project: Use of SCD’s Pre-op/Inter-op/ and Post-op All C/S’s, (including emergencies) Gyn & Uro Gyn Surgery Pre-Op Holding: SCD’s attached & working Time attached: Time off to transfer to OR: If not attached was this a crash C/S? Y N If no, give reasons: a. not available b. other _____________ Y N OR: SCD’s reattached & working Time reattached: Time off to transfer to PAR: Y N If no, give reason a.not available b.other _____________ PAR: SCD’s reattached & working: Time reattached: Time off to transfer to room: Y N If no, give reason a.not available b.other ______________ Transfer to room: SCD’s reattached & working Time reattached: Y N If no, give reason a.not available b.other ______________ Was heparin prophylaxis administered intraoperatively? Criteria: Circle all that apply. Prolonged surgery Obesity Hx. of PE or PVE Varicose veins Hx. of thrombophillia Cancer Estrogen use Venous disease Heparin prophylaxis administered Y N

7. Results

8. Analysis/Discussion Storage of SCD’s in the L&D Pre-op holding area has improved compliance Data sheets with VTE prophylaxis guideline are attached to the Pre-Op Check List as a reminder for RN’s Hand off to Women’s Health includes status of SCD’s

9. Next Steps Begin to audit heparin prophylaxis in patient’s who meet the VTE Risk Criteria Develop a standardized VTE Prophylaxis Protocol Include VTE prophylaxis in standing orders sets Education of Anesthesia Personnel, Surgeons, and nursing staff