Implementing the Form
The charter team still had to decide how the form would be presented to physicians and nursing staff. “We learned that there are no such things as standing orders,” says Dr. Franko. “But we can make the form a permanent part of each patient record, so that it cannot be discarded.”
The next hurdle was educating the staff, particularly nurses, on the new quality-improvement program. The team timed the implementation of the new process so that it began in March 2005, DVT Awareness Month. “We used the posters and giveaways provided by the Coalition to Prevent DVT to boost awareness in the staff,” says Peters. In April and May, the form went live.
“We used it for three months, then got information back from the nursing staff,” recalls Peters. “We went back to the committee with some suggested changes.” One of those changes was the inclusion of step 3: information on whether the patient was already receiving VTE prophylaxis.
The second wave of staff education began in late November, and the nursing staff continues to address the form in their bimonthly meetings. “Nurses fear the form, because they think it’s an order,” says Peters. “The top [of the form] will be done, but the bottom will be completely blank.”
She is working to educate nurses so that they are more comfortable with the form, and she has created an e-learning module with detailed information to supplement the form.
“This was a wonderful multidisciplinary effort,” says Dr. Franko. “I feel that the nursing service in particular has done a superb job. They get all the credit for this.”
Carolyn Webster, RN, vice president, Carilion Medical Center Nursing Operations, adds, “I’m happy that patients are being treated.”
First Findings: Dramatic Improvement
In May 2005, within two months after implementing the form, the charter team pulled 70 random patient charts to check their progress.
“We found that we had increased the percent of prophylaxis by SCD, low-molecular-weight heparins and unfractionated heparin [from 30%] to 60%,” says Dr. Franko. “And in June and July of 2005, we pulled 70 charts again. Eighty-seven percent of the patients had received prophylaxis. We were pleased with that increase.”
An Ongoing Process
When this period of education is over and any changes are made to the form and the process, the charter team will continue to meet once or twice a year to track progress and watch for problems.
“I’m not convinced that we’re going to sustain those numbers,” says Dr. Franko of the 87% success rate. “I hope we can keep the score up, but it’s going to take constant re-education.”
One positive factor was that the hospital’s staff is now well educated about VTE prophylaxis, so awareness continues to remain high.
The project will continue—and it will continue to be a work in progress. “We’re always relying on staff feedback to make [the form] more user-friendly,” says Dr. Franko. “And the prophylaxis may change over time, too.” TH
Contributing Writer Jane Jerrard is based in Chicago.