VTE

3 Key Lessons Learned for Implementing OB VTE Safety Recommendations

By Lynn Razzano RN, MSN, ONCC (Clinical Nurse Consultant, Physician-Patient Alliance for Health & Safety)

On June 18, 2014, approximately 250 attendees at the annual conference of AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses) attended the panel presentation entitled: “Implement VTE Change in OB Practice.“

With me on the panel were the following health experts:

  • Lisa Enslow, MSN, RN-BC (Nurse Educator, Women’s Health and Ambulatory Care Services, Hartford Hospital)
  • Sue Gullo, MS, RN (Director, Perinatal Improvement Community)

The following questions were asked by attendees post presentation and these answers provide three critical lessons learned from Implementing OB VTE Safety Recommendations from AHWONN Presentation:

  • Question: What is the biggest challenge to implementing the OBVTE Safety Recommendations?
    • Answer: The biggest challenge is the “buy in’” and support from upper level management that this is necessary. Once this is accomplished, education/staff training and including OB staff in implementing is key for success.  Don’t forget to engage the patient in the entire process as they are the ones that will benefit most from the new OB practice change and implementation of the OB VTE Safety Recommendations.
  • Question: In terms ofSCIP compliance, my institution’sSCIP specialist insists that venous foot pumps cannot be used in the OB patient population as there are no publications evidencing support of this use. She says it is nonSCIP complaint. Our OBVTE rates are great with use of venous footpump- how should we respond
    • Answer: SCIP is a surgical improvement project – it is not a regulation and OB patients fall into the highest risk category as do Orthopedic patients. If we use that information as baseline then the use of venous foot pumps are acceptable mechanical option for VTE prevention. In terms of the Obese to morbidly Obese Pregnant women, SCD compression sleeves even the extra-large would not fit the patient or have the potential for harm to the skin- Venous foot pump‘s should be the optimal choice and are equivalent to thigh high compression in terms of VTE efficacy.
  • Question: We do not have enough pumps for every OB patient. How do we get more pumps?
    • Answer: You need to make your case and justification to upper level management and be sure and include biomedical. Ideally your goal should be one pump for every OB unit bed that way you ensure that one is present for every admitted patient.
  • Question: We have reviewed current literature and there does not seem support for the use ofTEDS stocking orGCS- what are your thoughts?
    • Answer: There are publications for support and use of TEDS stocking in combination with compression either SCD or Venous Foot pump for maximal VTE prevention. If you go back to Virchow’s Triad, which provides three reasons why clots form and why we want to prevent. The causes of blood clots are: venous stasis, vessel wall damage, and hyper-coagulopathy.

The Three “Pillars” Of Virchow’s Triad Are:

o   Stasis is the circumstance when blood flow is altered, interrupted, or slowed down.  Most often stasis occurs when patients are sitting, as when stuck at desk or a plane seat, and the blood pools in the legs.

o   Injury to a Vessel Wall can occur from shear stressing, such as C section surgery or morbidly obese condition.  The body typically has an inflammatory response to these injuries which activates platelets to begin “clumping” at the site of the injury.

o   Hypercoagulability is the condition when the blood chemistry changes and makes the blood more prone to clot.  Obesity, smoking and the condition of pregnancy are major factors in the incidence of hypercoagulability. It can also arise from a person’s genetic makeup, illnesses, and trauma.

o   Combined Modalities is the current clinical term of using GCS (TEDS) in combination with Compression either SCD or venous foot pumps to address all 3 aspects of Virchow’s Triad. This will maximally prevent VTE in you OB patient population.

 

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