Preventable vs Non-Preventable VTE in Hospitalized Patients

Abstract

SESSION TITLE: Education SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 25, 2016 at 02:45 PM - 04:15 PM PURPOSE: Currently venous thromboembolism (VTE) is still considered a common preventable condition in hospitalized patients. However a significant proportion of VTE cases occur in patients who have received appropriate prophylactic measures according to the current guidelines. Financial implications for healthcare institutions for quality performance and costs incurred from the event can be substantial. We propose a classification system for preventable VTE versus non-preventable VTE cases based on compliance with appropriate prophylaxis based on current evidenced based guidelines. METHODS: Patients with hospital acquired VTE were identified in an academic tertiary care center. 120 cases during January 2015 to February 2016 were randomly selected for analysis for adherence to VTE prophylaxis guidelines. VTE prophylaxis compliance was based on American College of Chest Physicians 9th edition (ACCP) guidelines. Prescription order compliance was defined by appropriate pharmacological and/or mechanical prophylaxis being prescribed for the patient if indicated. Mechanical prophylaxis compliance was defined as appropriate adherence to mechanical prophylaxis during the indicated period. Pharmacological prophylaxis compliance was defined as appropriate dosing being administered during the indicated period. If there was full compliance with the measures, then health care delivery was termed as ‘optimal’ or defect-free. If any hospitalized patients develop VTE despite optimal care, it was classified as potentially non-preventable VTE. If any lapse in adherence to the guidelines was identified, it was termed as ‘sub-optimal’ care. The VTE cases resulting from sub-optimal care were classified as potentially preventable. An algorithm for classification of Hospital Acquired VTEs was developed using the above defined compliance measures. RESULTS: One hundred and twenty hospital acquired venous thromboembolism events were analyzed. 42 of 120 (35%) VTE cases are potentially preventable and 78 of 120 (65%) are potentially non-preventable. Pharmacological prophylaxis was ordered in 97.5% and mechanical prophylaxis was ordered in 89.16% prior to the development of VTE. Gap in pharmacological prophylaxis was found in 16 cases (13.33%), 15 cases (12.5%) had gap in mechanical prophylaxis and gaps in pharmacological and mechanical prophylaxis was found in 11 cases (9.12%). CONCLUSIONS: Majority (65%) of hospital acquired VTEs are Non-Preventable based on compliance with the 9th edition ACCP Guidelines for VTE prevention. CLINICAL IMPLICATIONS: Quality performance measures should target preventable VTE events rather than all hospital acquired VTE episodes. DISCLOSURE: The following authors have nothing to disclose: Shekhar Patil, Mary Ayad, Shethia Maithili, Bela Patel No Product/Research Disclosure Information