Clinical Tip, VTE

Four simple safety steps pave the OB DVT Prevention Road

By Lynn Razzano, RN, MSN, ONCC

In a recent article “Safety: 4 Ways to Stop DVT in Its Tracks”, Cheryl Marsh provides four very useful steps to prevent deep vein thrombosis (DVT). As she writes, this is patient safety issue that needs attention:

“The stakes are high when it comes to preventing deep vein thrombosis and pulmonary emboli. Between 300,000 and 600,000 people suffer DVT and PE each year, with 60,000 to 100,000 ultimately dying from the complications. When it’s not fatal, DVT can cause post-op morbidity, prolonged hospitalization and increased healthcare costs.”

More alarming is that the risk of DVT and PE (otherwise known as venous thromboembolism or VTE) escalates for pregnant women, as Dr. Andra James (Professor of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Virginia School of Medicine) points out:

“For pregnant women, the risks of VTE is 4-5 times higher than women who are not pregnant. Moreover, this risk is at least twice as much following cesarean delivery.”

In reviewing the alarming statistics for pregnant women and their inherent risk for VTE occurrence, can four safety steps make the difference in prevention from a silent killer?

The facts:

  • Pulmonary embolism (PE) has been a leading cause of maternal mortality in the United States since 1985. More maternal deaths have occurred due to PE than by hypertensive disorders, obstetric hemorrhage, obstetric infection, and ectopic pregnancies.
  • One woman in a thousand will experience a VTE during her pregnancy and the risk doubles for Cesarean section.

All pregnant women should be assessed consistently for the risk of VTE. This is what will guide the clinician in the ordering and initiating the appropriate DVT prophylaxis in a timely manner.

To know the risks, here are some useful steps:

Step 1 – Know the risks: pregnant women are four to five times more likely to develop VTE.

Step 2 – Select the correct prophylaxis and the two most effective measures are either sequential compression devices or venous foot pumps, otherwise known as intermittent pneumatic compression devices [cite ACOG guidelines]

Step 3 – Establish standard procedures and protocols to ensure consistent delivery of quality care. The Physician-Patient Alliance for Health & Safety, together with a panel of health experts, is developing safety recommendations to prevent VTE in maternal patients.

Step 4 – Educate patients on why VTE prevention matters and why they need to wear Intermittent pneumatic compression devices is a crucial part of compliance and empowering the patient for her own self care management. Risks of VTE remain even after the patient is discharged and in OB the risk window remains up to one month post-partum.

Is it really as simple as 4 safety steps? Yes, that is all it takes to stop the clot! Do it consistently, every time, for maximal patient protection from VTE harm and ensuring safe and effective positive patient outcomes. We owe it to all pregnant mothers and their families!

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