January 15, 2012—Venous Thromboembolism (VTE) Prophylaxis
Most patients admitted to MGH must have an assessment for VTE (venous thromboembolism) documented in POE by an MD, NP, or PA. If the patient is at risk for VTE, and there is no reason not to, the provider must order prophylactic treatment. This fulfills important requirements set by the Centers for Medicare & Medicaid Services (CMS) to demonstrate meaningful use of the EHR (electronic health record). VTE is a leading cause of poor outcome for inpatient treatment, and the timely use of pharmacological and/or mechanical prophylaxis is proven to prevent VTE.
The prompt to assess the risk for VTE occurs when the provider signs orders for a patient. If indicated, one or more treatments can be ordered directly from the prompt. VTE prophylaxis can include medications recommended by the MGH Medication Education Safety & Approval Committee (MESAC), or mechanical means (pneumatic boots or TED stockings), or both. The prompt includes a link to the Anti-Coagulation Guidelines from MESAC.
The prompt takes into account whether the patient already has orders for VTE prophylaxis. Pharmacological and mechanical treatment must be considered separately. To decline either order type, you must select the reason. Each reason for declining is stored as a general care order.
Some care units, such as fetal/maternal medicine and psychiatrics, are exempt from this requirement.
Key Elements:
VTE assessment is required for all adults, as well as pediatric patients age 18 who have a confirmed weight on file greater than 40kg, within the first 24 hours of admission, except for patients in maternity, labor and delivery, PACU, and psychiatry care units
VTE assessment is required for all adults, as well as pediatric patients age 18 who have a confirmed weight on file greater than 40kg, admitted to an the intensive care unit, regardless of the length of stay
Providers can defer the assessment by selecting a reason at the prompt, which is filed as a general care order
Any MD, NP, or PA writing orders is prompted on signing, until the need for treatment is addressed
Providers must reassess when discontinuing orders for VTE prophylaxis, unless the orders are replaced
Providers must reassess on signing orders for transfer to another care unit, unless the orders are carried forward
Instructions:
See also: