Optimizing Patient Safety Culture

Hospital Acquired Conditions such as Venous Thromboembolism (VTE) represent dangers to patients’ safety and to care providers’ quality metrics, reimbursement rates, and patient satisfaction scores. Thought leading provider organizations strive to integrate patient safety into their enterprise’s culture in order to provide a solid foundation for individual efforts to target reductions in HAIs such as VTE. This Guide to Value will describe how 2013 Davies Award winner Texas Health Resources reduced Venous Thromboembolism (VTE) using Clinical Decision Support interventions. Due to the patient safety cultural foundation and the direct efforts of involved stakeholders, THR was able to over a two year period (2008- 2010):

 

  • Prevent 404 preventable VTE events
  • Avoid $6,060,0004 VTE-related costs.
  • Decrease the number of VTE’s over 4 years by 50%

Need more information on Patient Safety resources or how to get involved with the community? Connect with Jonathan French at jfrench@himss.org.

Develop a Standardized Approach to Preventing VTE

In 2008, Texas Health Resources aimed to develop a standardized approach to preventing hospital acquired VTE by identifying patients at risk and applying appropriate intervention strategies from national guidelines and evidence-based practices. To achieve this goal, Texas Health implemented health care IT and clinical decision support tools such as:

 

  • order sets
  • best practice advisories
  • a VTE risk-assessment calculator
  • Align project goals with national and organizational priorities
  • Involving appropriate bodies and stakeholders to achieve system level consensus regarding standardization details.
  • Utilize clear, concise communication and education to provide busy caregivers
  • Providing caregivers access to drill-down data.
Embed VTE prophylaxis evidence and measures into CPOE order sets

Conduct a VTE prophylaxis pilot for specific CPOE order sets (ex. post-operative) mandated selection of VTE prophylaxis or reason not ordered. For Texas Health, the outcome was favorable, with 100-percent compliance when pilot order sets were used. To mitigate the risk of decreased order set use, the system phased in mandatory selection for appropriate order sets.

Establish Best Practice Advisories (BPA)

Texas Health established physician and nurse best practice advisories (BPA) for ordering VTE prophylaxis.

For patients at least 18 years of age and hospitalized for 18 hours or longer (with certain contraindicated patients excluded):

 

  • BPAs fire every four hours until the physician orders VTE prophylaxis or documents why not
  • Nurses receive BPAs every four hours until they contact a physician.
Resources

STEPS to Value: Honoring Humanity in the Time of Technological Change: THR’s Chief Health Information Officer, Ferdinand Velasco, MD, describes THR’s approach to change management and their patient safety culture.

Develop Risk-Assessment Tool

Develop a risk-assessment tool for front line staff to utilize. THR used a modified Caprini VTE Risk Assessment Tool and converted it to an electronic patient-specific risk calculator accessible from within the patient context of the EHR. This intervention provides recommended VTE prophylaxis based on the patient’s risk score.

Analyze outcomes of pilot project

Review the pulmonary emboli/deep vein thrombosis rates targeted of your VTE Reduction through CDS Intervention pilot project.

 

  • Review of the number of advisories
  • Review clinician’s response to advisories
  • Review the timely and appropriate use of VTE prophylaxis
  • Convert administrative (charge) data into clinical EHR data