Do you use a DVT/PE Risk Assessment Tool?

[november17, ASN, RN]

Does anyone currently use a standardized DVT risk assessment tool where they work? If so, which one do you use, what do you think of it, and do you think it is effective?

Thanks.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Yes. Ours addresses current anticoagulant use first of all. Then it goes on to identify risk factors pertaining to certain age groups. My concern with it, which I frequently verify with our pharmacy, is that the anticoagulants the form asks about doesn't address the use of newer ones like Effient and there is another one that the name escapes me at the moment. So, if I select 'no' to the question of usage of the ones listed, I always write on the form the one that they are taking and I call the pharmacy AND I flag the form for physician review before they go directly to ordering SQ injections. Not everybody does this but until the forms are updated to reflect the use of ANY or ALL anticoagulants, we need to be relentless with this. I even indicate if a patient has taken a regular strength aspirin several times a day. A lot of patient's deny this particular usage but when I ask about BC powders or Goody powders, I get the deer-in-the-headlights look from those who down those things so much that they are accustomed to the taste and need no water. Ive found that a lot of headache sufferers take these but with it being OTC, fail or don't think to mention these when they come to the hospital for other more pertinent injuries or illnesses. I know these two OTC are not intended for DVT/PE prevention but their usage or recent usage prior to being placed on anticoagulant therapy could have very undesirable effects.

So.....that's my two cents worth.....for what it's worth.

[Nurse Kyles, BSN, RN]

Yes we have a dvt prophylaxis screen as part of the admission set. It sounds similar to the one previously mentioned. At the top it lists certain anticoagulants & if the patient is on any of the list you don't have to go through the rest of the assessment. The admission orders also have non-pharmacological interventions automatically checked which are implemented based on score. Something like for score 3-5 SCDs are automatically ordered. This was new when we rolled out the new admission sets to make it easier for the physicians as we switched to physicians entering their own orders this past March. The only problem we have had is that basically every patient is indicated to have SCDs & our hospital sometimes runs out now!

[delilas]

Our admission orders require a doctor to choose a pharma or mechanical VTE prophylaxis (usually lovenox or SCDs or both), or document a reason why they aren't ordering it. It's a fairly recent change; in January, we had to call docs on every admission to ensure we got those orders if they weren't done already. The docs complained, and now it's built into our system.

We do also have the ability to assess & document on homan's sign and the rest as necessary; it's all built into our build of EPIC.

[november17, ASN, RN]

Thanks, I'm on a newly formed interdisciplinary DVT prevention committee and we're exploring the options. We are in the process of developing an order set for Epic. One of the ideas was doing DVT risk assessment at admission, like fall risk or braden.

Most of the time the admitting is good about ordering interventions and the nurses catch the ones that dont, but there is the occasional patient that slips through the cracks. We have an above average DVT/PE rate for some reason. Trying to figure it out and improve.

[HyperSaurus, RN, BSN]

We have one, but it's a tool the docs use as part of the standard admission order set

[november17, ASN, RN]

We have one, but it's a tool the docs use as part of the standard admission order set

I'm helping to develop the order set. We're trying to get the nurses involved in the assessments to help catch the patients that slip through the cracks and remind the doctors if need be. (You know how that goes).

[comm]

I'm a bit confused, According to this assessment tool, every 75+ yr old person would be on lovenox because they have a risk score of 3. Regardless of if they have no other risks, their age alone dictates lovenox injections? That cannot be right.

[Pat_Pat RN]

I'm a bit confused, According to this assessment tool, every 75+ yr old person would be on lovenox because they have a risk score of 3. Regardless of if they have no other risks, their age alone dictates lovenox injections? That cannot be right.

You are correct. At my hospital, unless a patient is one who is walking all the time, they get Lovenox or heparin, every one. The docs do the ordering of this, so I don't exactly know all the ins and outs of it.

[calivianya, BSN, RN]

VTE prophylaxis is part of the mandatory admission documentation, so right then we'll be reviewing our orders and see what we have. It's also part of the regular assessment charting as well as what we chart on q2h under daily cares. You better believe none of us are comfortable charting "No DVT prophylaxis" unless there's an order for no DVT prophylaxis, so we are pretty good at staying on top of the physicians to make sure we have adequate orders.

Oops, just noticed the age of this thread. Oh well.

[Here.I.Stand, BSN, RN]

Every one of our pts are high risk. I'm not sure if the MDs/NP have a tool, but every day in their progress notes they include VTE prophylaxis as part of their review of systems. We get so many brain bleeds (traumatic or spontaneous) that for a good number of pts, it's contraindicated, and the docs put that in their note. On the nursing side, we use Epic so click the options we are using. If pharm methods are contraindicated we click that they are contraindicated, and that we are using SCDs or whatever.