Awareness and Best Practices Regarding Deep Vein Thrombosis Panel #5
Surgeon General's Workshop on Deep Vein Thrombosis
Franklin A. Michota, MD
Head, Section of Hospital Medicine
Division of Medicine
The Cleveland Clinic Foundation
- We recommend that every hospital develop a formal strategy that addresses the prevention of thromboembolic complications.
Image of the cover of Chest 2004
- Appropriate VTE prophylaxis in patients at risk
(ballon pullquote) AHRQ Top patient safety practice according to strength of evidence
- Perioperative beta-blockade
- Maximum sterile barriers for CVC insertion
- Perioperative antibiotics to reduce post-surgical infections
- Patients restating / recalling what they have been told during informed consent
- CASS (continuous aspiration of subglotic secretions) to prevent ventilator pneumonia
- Pressure-relieving bedding to prevent pressure ulcers
- Real-time ultrasonography to insert CVCs
- Self-management of warfarin
- Nutritional support post op and critically ill
The Agency for Healthcare Research and Quality has recently sponsored a report entitled "Making Health Care Safer: A Critical Analysis of Patient Safety Practices". This report summarizes a systematic review of 79 patient safety interventions based on the strength of the evidence supporting more widespread implementation of these procedures. Here are the top ten safety practices according to the strength of the evidence
As you can see, the highest ranked safety practice was the appropriate use of prophylaxis to prevent VTE in patients at risk.
Photocopy of USA Today article – Wednesday January 21, 2004
(Balloon pullquote) “…doctors are not doing enough to prevent DVT cases.”
The disconnect between evidence and execution as it relates to DVT prevention amounts to a public health crisis"
Samuel Z. Goldhaber, M.D.
- Less than 25% of respondents are aware of DVT
- Male sex, age<35 years, and lesser education are associated with lower DVT awareness
- Of those with some DVT awareness
- Only 46% were familiar with any signs or symptoms
- Only 43% had any knowledge of risk factors
- Only 25% were aware DVT could be prevented
- APHA/CDC Public leadership conference
- 60 thrombosis experts
- Increased diligence to prevention
- Raise public awareness
February 26, 2003; Washington DC
- Public awareness campaign
- Communication tools
- State licensing boards
- Physician education
- National standards
Coalition to prevent deep vein thrombosis logo
Screenshot photo of the Website
Photo of a speaker at DVT Awareness Month
Examples of Grassroots Out-reach From Coalition Members web site screenshots
Photos of media outlet logos
Photo of 'Are you at risk for DVT?' brochure
- Deep Vein Thrombosis Awareness Month – March 2005
- Sen. Arlen Spector (R-PA)
- Sen. Byron Dorgan (D-ND)
- Sen. Sam Browback (R-KS
- In honor of the memory of David Bloom
- NQF Safe Practices for Better Healthcare Consensus Report
- 30 healthcare safe practices that should be universally utilized in applicable clinical care settings to reduce the risk of harm to patients
"Evaluate each patient upon admission, and regularly thereafter, for the risk of developing deep vein thrombosis/venous thromboembolism"
- Utilize clinically appropriate methods to prevent DVT/VTE
To answer this question, we can turn to the National Quality Forum for some practical advice. The National Quality Forum or NQF has issued a consensus report that details 30 healthcare practices that should be universally utilized in applicable clinical care settings to reduce the risk of harm to patients. Although this set of safe practices is not intended to capture all activities that might reduce adverse healthcare events, it has been carefully reviewed and endorsed.
From the NQF consensus report, it is recommended that patients should be evaluated upon admission, and regularly thereafter, for the risk of developing deep vein thrombosis or venous thromboembolism. Furthermore, we should be utilizing clinically appropriate methods to prophylax against DVT which may lead to PE.
My personal interpretation of these last several point is that we need to be looking at patients that enter our institutions for their respective risk of developing VTE, take the necessary steps to prevent VTE with appropriate strategies, and recognize that such an activity would improve quality of patient care and save money.
What about your interpretation and conclusion?