Download or read book Implementation of a Standardized Protocol for the Identification and Treatment of Hospitalized Patients at Risk for Venous Thromboembolism written by Sharon L. Falke and published by . This book was released on 2011 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: There are nearly 900,000 cases of venous thromboembolism yearly in the United States with over 300,000 deaths, a figure that exceeds that of most other diseases. This incidence rate is echoed in global studies, with an acknowledged poor adherence to clinical practice guideline recommendations for the prevention of this serious hosptial-acquired condition. Venous thromboembolism is the primary patient safety concern for many of the health care regulating bodies, including the Centers for Medicare and Medicaid, National Quality Forum, and The Joint Commission. It has been recognized as the most preventable cause of hospital deaths; therefore, many insurance payers will limit reimbursement for the added cost of care required in the event of this complication. Arizona hospitals are in the median range when evalutated for compliance with the guideline recommendations and for initiating venous thromboembolism prophylaxis, with a moderate improvement noted in those partiicpating in more closely monitored programs. This capstone project was initiated at a small community hospital that initially had an abysmal rate of adherence with the prevention protocol, and seldom acknowledged the disease risk during patient assessments, with the goal of improvement in regulatory comliance and amelioration of patients safety with a reduction in morbidity and mortality. The theoretical foundation for this project was the Rosswurm and Larrabee conceptual model and the constructivism adult learner theory; additionally, protocols and an audit-feedback system were used as a reinforcement tool. This project was initiated as part of the admission process for inpatients, with each patient expected to be assessed for venous thromboembolism potential within 24 hours using the Caprini risk assessment model. The hospitalist clinicians were provded copies of the model along with the accompanying instruction tool during an educational briefing. Once they were aprised of the disease risks, patient benefits, regulatory requirements, and financial incentives, copies of the risk assessment tool were placed on each medical chart and at each dictation station as a reminder of the protocol. During the first month of this project evaluation, an improvement was noted in guideline adherence from 23% to over 59% of patients assessed for risk and of those found to be at risk, the percentage of patients actually receiving treatment increased from 31% to 77%, demonstrating significant improvement. The expected improvement outcome is 25% to 40% with the use of similar methods as this project. The primary adverse effect of chemoprophylaxis is hemorrhage; however there were no incidences of increased bleeding noted during this evaluation and three incidents of deep vein thrombosis in untreated patients, clearly illustrating the importance of this therapy. This project demonstrated the critical importance of recognizing the risk for thromboembolism, determining the appropriate therapy with consideration for confounding factors, and administering that therapy for an adequate time period. This project supports the recommendations of the clinical practice guidelines and the governmental regulations surrounding the issue, and provides the hospital with a framework for compliance with accreditation and regulating core measures.