mcic vte prophylaxis all team call
Download
Skip this Video
Download Presentation
MCIC VTE Prophylaxis All Team Call

Loading in 2 Seconds...

play fullscreen
1 / 17

MCIC VTE Prophylaxis All Team Call - PowerPoint PPT Presentation


  • 82 Views
  • Uploaded on

MCIC VTE Prophylaxis All Team Call. Sean Berenholtz, MD MHS and VTE Subcommittee 5.23.2006. MCIC VTE Subcommittee. Safety Measures. How often do we harm patients? Measures of harm (Surgical site infections (SSI)) How often do we do what we should?

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'MCIC VTE Prophylaxis All Team Call' - stew


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
mcic vte prophylaxis all team call

MCIC VTE Prophylaxis All Team Call

Sean Berenholtz, MD MHS

and VTE Subcommittee

5.23.2006

safety measures
Safety Measures
  • How often do we harm patients?
    • Measures of harm (Surgical site infections (SSI))
  • How often do we do what we should?
    • Surgical Care Improvement Project (SCIP) process measures,
    • Venous thromboembolism (VTE) prophylaxis,
  • How often do we learn from defects?
    • Learn from one per month (National Quality Forum never events, mislabeled specimens)
  • How well do we improve culture?
    • Safety Attitude Questionnaire (SAQ),
    • Comprehensive Unit Safety Program (CUSP)
most common preventable cause of hospital death
Most common preventable cause of hospital death

Annual Incidence in US

Hirsh DR et al. JAMA 1995;274:335-7

Bick RL Semin Thromb Hemost 1999;25:251-3

slide5

Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.

Chest. 2004 Sep;126(3 Suppl):338S-400S

recommendations
Recommendations
  • General surgery
    • surgical oncology, gynecology, urology, vascular, transplant, thoracic surgery
  • Orthopedics
  • Trauma
  • Neurosurgery
overall adherence for vte prophylaxis at jhhs baseline
Overall Adherence for VTE Prophylaxis at JHHS: Baseline

n = 71/219*

n = 7/8

n = 3/13

n = 20/88

n = 13/44

n = 1/4

n = 12/16

n = 12/31

n = 3/15

* Aggregate DOES NOT INCLUDE GU cases that were contraindicated for pharmacologic interventions

scip measures
SCIP Measures
  • SCIP VTE 1: Surgery patients with recommended VTE prophylaxis ordered
  • SCIP VTE 2: Surgery patients who received appropriate VTE prophylaxis within 24 hours prior to surgery to 24 hours after surgery
  • SCIP VTE 3: Intra- or postoperative PE diagnosed during index hospitalization and within 30 days of surgery (OUTCOME)
  • SCIP VTE 4: Intra- or postoperative DVT diagnosed during index hospitalization and within 30 days of surgery (OUTCOME)
assumptions
Assumptions
  • Data collected in immediate periop period (preop holding area thru time of PACU/ICU admission
  • Concurrent data collection preferred
  • Risk stratification defined by local consensus
  • Evidence of risk stratification includes a completed risk stratification tool, a physician, NP, or PA note documenting that the patient is at risk for VTE
  • Exclusions: < 18 yo, hospital LOS < 24 hours
proposed mcic vte measures
Proposed MCIC VTE Measures
  • General surgery (includes surg onc, urology, vascular and transplant surgery)
  • Trauma
  • Neurosurgery (intracranial, spinal cord injury, elective spine surgery)
  • Bariatric surgery
proposed mcic vte measures1
Proposed MCIC VTE Measures
  • Documentation of Risk Stratification
    • % patients with evidence of risk stratification in chart
  • Prophylaxis for VTE
    • % patients who have an order written to start prophylaxis during the time period within 24 hrs prior to incision through 24 hrs after surgery end time
    • % patients who have an order written to start prophylaxis at the recommended dosing during the time period within 24 hrs prior to incision time through 24 hrs after surgery end time
proposed mcic vte measures2
Proposed MCIC VTE Measures
  • Contraindications to VTE prophylaxis
    • % patients with any contraindication to pharmacologic prophylaxis
    • % patients with contraindication to pharmacologic prophylaxis due to a high risk of bleeding treated with mechanical prophylaxis (GCS or IPC or SCD)
  • % patients included in review process

GCS: graduated compression stockings; IPC: intermittent pneumatic compression devices; SCD: sequential compression devices

data collection plan
Data Collection Plan
  • Data collection tool developed
  • Pilot testing: June 2006
    • Concurrent data collection: convenience sample of 5-10 pts
    • Retrospective Review: 10 randomly selected patient-charts
  • Implementation: July 2006
    • Concurrent data collection: All patients seen by the clinical area improvement team
    • Retrospective Review: 10 randomly selected patient-charts per month per surgery type
  • Maintenance: >= 90% performance
    • TBD
reports
Reports
  • Single period reports
  • Performance over time
  • Comparison to collaborative
  • Data remains anonymous
change is local
Change is Local
  • Educate staff
    • Partner with hematology, Guidelines, Fact sheet, powerpoint slides
  • Reduce complexity
    • Standardized tool, computerized decision support
  • Create redundancy
    • Multidisciplinary teams, add to existing checklists, briefings/debriefings
  • Measure performance
    • Identify when this will occur during the periop period
team check up tool
Team Check-up Tool
  • Reviewed data with team
  • Number of team meetings
  • Met with executive
  • Reviewed data with executive
  • Barriers to progress
next steps
Next Steps
  • Finalize teams
  • Gain consensus on evidence and risk stratification
  • Pilot test data collection tool
  • Conference call to review pilot phase
    • Burden, revise measures/tools, timeline
  • Live the grid
  • Conference calls for sharing
ad