Congress Abstracts 2006

113

IMPLEMENTATION OF VENOUS THROMBOEMBOLISM PROPHYLAXIS GUIDELINES ON A GYN ONCOLOGY IN-PATIENT NURSING UNIT. Jerelyn Osoria, RN, OCN^®, Dorothy Dulko, PhD(c), MS, NP, AOCN^®, and Blanca Vasquez-Clarfield, MA, Memorial Sloan-Kettering Cancer Center, New York, NY.

Acute venous thromboembolism (VTE) is a common complication in hospitalized patients, with oncology patients being at particularly high risk. National expenditures associated with VTE represent a health care burden of approximately 1.5 billion dollars annually. Although research supports the clinical benefit of preventing VTE in acutely ill, hospitalized patients, it is suspected that prophylaxis is underutilized. Ongoing review of practice patterns, with feedback of data to clinical staff, may increase compliance with established guidelines for VTE prevention.

The standard regimen for VTE prevention in hospitalized patients is the usage of sequential compression devices (SCD) with or without low molecular weight heparin (LMWH). The purpose of this project was to evaluate and improve compliance with recommended VTE prophylaxis guidelines within this NCI-designated cancer center in-patient Women's Oncology Unit.

An interdisciplinary VTE prophylaxis committee was developed and in turn initiated a computerized order entry set containing standard guidelines for VTE prevention. This order entry set provides recommendations tailored to the admitting service and patient's profile. GYN surgery and medicine providers were educated as to the importance of VTE prevention and were given feedback on service-wide compliance with ordering of prophylaxis. Daily floor rounds were performed to assure the placement of SCD's at the bedside; with flow sheet documentation of implementation. Monthly educational sessions were held for all of the nursing staff; including feedback of compliance data.

Preliminary data revealed that there was discordant compliance with provider initiated VTE prophylaxis between GYN Medical Oncology (overall 38% without admission VTE prophylaxis order) and GYN Surgical Oncology (overall 8% without admission VTE prophylaxis order) for the period of May-November 2005. Following education and compliance feedback preliminary data for December 2005 suggests improved compliance. Nursing documentation and chart audit is ongoing to determine trend and compliance in nursing staff patterns.

Greater awareness of VTE prophylaxis is a priority for all patients at risk, especially for hospitalized cancer patients who often do not receive appropriate antithrombotic therapy. Oncology nurses have the opportunity to streamline the approach to prevent VTE by ensuring effective prophylaxis administration according to easily implemented guidelines.