By Lisa Enslow, MSN, RN-BC (Nurse Educator, Women’s Health and Ambulatory Care Services, Hartford Hospital) and Lynn Razzano, RN, MSN, ONCC (Clinical Nurse Consultant, Physician-Patient Alliance for Health & Safety)
[Editor’s note: PPAHS is web-enabling the OB VTE Safety Recommendations. If you are interested in the web-enabled version, please download the OB VTE Safety Recommendations to add your name to the contact list by going here: http://ppahs.org/ob-vte-safety-recommendations-pdf/]
The use of electronic medical records (EMR) is no longer an option, but a necessity in today’s healthcare environment. Many institutions are in the process of transitioning from paper to electronic documentation or upgrading to systems that manage records from one institution to another.
These transitions have clear benefits but can also present barriers when changes or additional pieces need to be added. This became the case when a prominent New England hospital began implementing an initiative to reduce rates of venous thromboembolism (VTE) among its patients. The hospital’s chief executives made the initiative a top priority after learning that its overall VTE rates were not favorable in comparison to national benchmarks. The comparison showed that the hospital’s surgery and trauma departments were most in need of improvement, while its obstetrics department showed the best performance.
As a result, a hospital-wide task force was formed to study the procedures that the obstetrics department was using to reduce VTE rates and see how these procedures could be incorporated in other departments. In particular, the task force focused on the “OB/GYN VTE Safety Recommendations for the Prevention of VTE in Maternal Patients” — guidelines developed in 2013 by the Physician-Patient Alliance for Health & Safety (PPAHS) that were being implemented in the obstetrics department.
When the task force reported that a key component of the PPAHS recommendations – , the hospital’s leadership team decided to incorporate the VTE Risk Screening tool in other departments. #VTE Risk Screening tool helped #obstetrics dept substantially lower incidences of VTE #ptsafety Click To Tweet
Along with helping lower VTE rates, the VTE Risk Screening tool has enabled the obstetrics department to manage medical records electronically – and the hospital is now looking to achieve similar results in other departments. This has created a host of challenges. For example, the hospital faced issues in bringing together five separate departments that were each practicing a bit differently.
- As other hospitals transition from paper to EMR, they may benefit by considering best practices observed – and the lessons that continued to be learned – at the New England hospital. These lessons include pre-identifying the clinical content expert personnel first and ones that are actively working in the OB units.
- Draft the OB clinical expert content and review the OB VTE Safety Recommendations so there is close alignment of both sets of information.
- Work closely with IT and an OB nursing informatics expert on how to adopt the recommendations into the current EMR being used.
- IT should be useful in developing the background infrastructure of the program so it can be used ”live”.
- Start a concentrated pilot on one of the OB units to identify if it is accurately reflecting all the VTE risks of the pregnant patients admitted.
- Be open and honest on what is working and what is not, this should be done in collaboration with IT and nursing informatics so any “kinks” in the system can be worked on.
- The final IT application that incorporates the maternal risk screen should ultimately be user friendly, easy to click on the VTE risks, ensure they populate for a final VTE score.
- The Computerized MD order entry screen should then be deployed with the options of VTE prevention prophylaxis to be selected.
- If there is a capability of inserting an electronic alert on the MD order screen after the VTE risk factors are populated, this should be done as it would help ensure no gaps in VTE prophylaxis.
- In terms of extra patient safety, hands off communication should be conducted for all that has been completed, ordered and initiated.
These above steps outline how to implement the OB VTE Safety Recommendation into current practice long before you transition hospital and network wide to a larger type of the final selected EMR system.
In conclusion, the points of emphasis are developing key working collaboration with the Nursing Informatics staff and staff who have initial contact with the pregnant patient. This may be the ED for those high risk patients that enter the health system pre and post-delivery. The remaining strategy entails developing consistent nursing expert content specific for the specialty and working with IT to create a workable framework for the Maternal VTE Risk assessment and specific prophylaxis orders.