Fellow leads the way to new VTE protocol

On April 6, a new protocol will take effect for every adult in-patient admission. The protocol, a simple process for providers, could make a world of difference to patients who are at risk for developing venous thromboembolism (VTE).

The protocol, a risk assessment, is initiated in CPOE (computerized physician order entry) when a patient is admitted. The assessment is meant to bring VTE risk to top of mind.  “I think it’s a really under recognized problem,” said Chris Taylor, M.D., a hematology-oncology fellow who has been the driving force behind the new protocol. 

Even though the assessment screen is a “soft stop” that is not required to be completed, Taylor says he hopes it becomes second nature for clinicians to take a minute to think about their patient’s VTE risk factors. The assessment screen links to a menu of prophylaxis options – both pharmacologic and non-pharmacologic – for high, moderate-high and low risk levels. This is UNC’s first formalized system for the disorder. “The goal is for every patient to have a formal risk assessment,” said Taylor.

He has worked on the protocol development as part his quality improvement and patient safety curriculum. Taylor said his first step was to gather mentors, like Dr. Stephan Moll and Dr. Brian Goldstein, who could be advocates for the effort. The UNC protocol was developed with the help of Greg Maynard, M.D., M.Sc., University of California, San Diego, who is a nationally-recognized expert on preventing VTE. Taylor met with in-patient service leaders across the hospital who provided feedback before the protocol was approved by the Pharmacy and Therapeutics (P&T) committee.

In addition to providing a formal risk assessment process for providers, part of the prevention effort is to educate patients on VTE. Every in-patient will receive an education sheet which includes information about risk factors, symptoms, and also a website for the National Alliance for Thrombosis and Thrombophilia where they can find more patient specific information.

“We had 30,000 adult admissions last year,” Taylor said. “The fact that this project could impact that many people is what I’m most happy about. I hope it will help educate people on VTE, whether it’s for themselves or others.”

When a blood clot forms within the veins of the legs, or less frequently the arms, it is called a deep vein thrombosis (DVT).  A DVT can cause pain and swelling in the affected extremity.  A pulmonary embolism (PE) occurs when a piece of the clot in the vein breaks off and travels to the lung.  A PE can cause chest pain, shortness of breath, and can be life-threatening.  DVT and PE together are referred to as a venous thromboembolism (VTE).

Close to 600,000 people develop VTE every year in the U.S., and a sixth of those cases are fatal. More than 50 percent of all VTE occurrences are hospital related.

VTE occurrences affect hospital quality rankings, and in the past UNC has ranked below the national average for VTE prevention. “This is not only important for patient care,” said Taylor, “but because we want to be the best hospital possible when it comes to these rates.” 

Taylor’s fellowship will be over this summer, but he says he’s not worried about things running smoothly when he’s not around. “So many of the people who have been so helpful through the whole process will still be here,” he said. Many of those people are on the VTE task force, whose goal is to continue to perfect the system and work out kinks as they come up, Taylor said. “I just really hope eventually the protocol becomes a part of the culture here.” 

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