Editor’s note: Blood clots are occurring in patients diagnosed with COVID-19. This article offers some of the key treatments and recommendations you may experience when admitted to hospital and then discharged home. As well, it discusses the interim clinical guidance from the Anticoagulation Forum.
By Michael Wong (Founder/Executive Director, Physician-Patient Alliance for Health & Safety)
An average of 274 people die from blood clots – which works out to about one death every six minutes. These statistics are pre-COVID statistics.
Because of the current COVID-19 pandemic, this may be changing. There have been reports about the development of venous thromboembolism (VTE) in patients with COVID-19. The International Society on Thrombosis and Haemostasis has collected a number of studies and case reports on thrombosis in COVID-19 patients, and the Journal of American College of Cardiology released a review of current understanding, citing many of the studies and case reports which are on the ISTH site.
This COVID-19 pandemic is proving a challenge for clinicians to care for patients diagnosed with COVID-19. The interim clinical guidance from the Anticoagulation Forum (AC Interim Guidance) discusses the challenges of diagnosing a thrombotic event in COVID patients:
Editor’s note: Our understanding of COVID-19 symptomatology is evolving as the current pandemic unfolds. The International Society on Thrombosis and Haemostasis has collected a number of studies and case reports on thrombosis in COVID-19 patients. The Journal of American College of Cardiology released a review of current understanding, citing many of the studies and case reports which are on the ISTH site. This COVID-19 pandemic challenges us to use current knowledge and innovate new approaches to care for patients diagnosed with COVID-19. This article seeks to summarize some of the current knowledge about thrombosis in COVID-19 patients, knowing that future studies and case reports will undoubtedly refine the statements made below. However, this is science, continually evolving and improving based on current understanding. With that, this article offers some insights about VTE in patients admitted to the hospital who have been diagnosed with COVID-19.
By Michael Wong (Founder/Executive Director, Physician-Patient Alliance for Health & Safety), Laurie Paletz, BSN PHN RN BC SCRN (Manager, Stroke Program Department of Neurology, Cedars-Sinai), and Thereza B. Ayad, RN, MSN, DNP, CNOR (Assistant Professor, University of Massachusetts Medical School-Graduate School of Nursing; Surgical Services Clinical Staff Educator, North Shore Medical Center)
(reviewed by Sue Koob, MPA, Chief Executive Officer, Preventive Cardiovascular Nurses Association and Pat Salber, MD, MBA, Editor-in-Chief, DoctorWeighsIn)
Articles the Physician-Patient Alliance for Health & Safety (PPAHS) have been reading the this past week.
Make the Operating Room Smoke-Free
Nurse Janelle Casanave, RN, urges you to make your operating room smoke-free:
Articles we have been reading this past week of April 16, 2018 ask us to reconsider how we think about patient safety.
#1 – COPD prevalence is nearly double in rural areas compared to metropolitan areas
The risk of COPD is nearly double in rural areas compared to that in urban areas, according to CDC’s Weekly Morbidity and Mortality Report.
Patient advocates and leading medical societies involved in awareness building and improving patient safety in Atrial Fibrillation (Afib) and venous thromboembolism (VTE) gathered recently for the 1st Annual Anticoagulation Summit, a two-day conference.
Michael Wong, JD, founder and Executive Director of the Physician-Patient Alliance for Health & Safety (PPAHS), presented a poster on the OB VTE Safety Recommendations, which were released by PPAHS, in collaboration with the Institute for Healthcare Improvement and the National Perinatal Association. The recommendations, compiled by a panel of health experts, give clinicians a step-by-step checklist to help assess all OB patients’ risks for VTE and identify the appropriate prophylaxis regimen to improve health outcomes for maternal patients. Read More
This week’s must reads focus on patient safety tools.
This week in #patientsafety, PPAHS announced our position that all patients receiving opioids must be monitored with capnography. From around the web, the American Journal of Nursing summarized venous thromboembolism (blood clots) guidelines from American College of Chest Physicians, Ontario released a dataset and tool to explore opioid-related morbidity and mortality, and Pain Medicine News discussed a researcher’s exploration of alternatives to opioids. Read More
This week in #patientsafety, we highlight again that it is Blood Clot Awareness Month. From around the web, three studies: one on the effect of hospital inspectors on patient safety; one on sepsis; and, one on the relationship between opioid supply levels and long-term use.
March is Blood Clot Awareness Month. Blood Clot Awareness Month is a time for us to highlight stories and resources that you can share with colleagues, patients, and loved ones to bring attention to blood clots.
From Around the Web:
When Hospital Inspectors Are Watching, Fewer Patients Die. A study published in JAMA Internal Medicine studied records of Medicare admissions from 2008 to 2012 at 1,984 hospitals and found that in the non-inspection weeks, the average 30-day death rate was 7.21 percent. But during inspections, the rate fell to 7.03 percent.
UAB study highlights risks of sepsis. A new study from researchers at the University of Alabama at Birmingham analyzing three different methods for characterizing sepsis has helped to illustrate the risk of death or severe illness attributable to the condition.
With a 10-day supply of opioids, 1 in 5 become long-term users. With an initial 10-day opioid prescription, about one-in-five patients become long-term users, according to data published Friday in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
We’d like to wish you a safe and healthy 2017.
As we prepare for 2017, we reflect back on the top 10 articles from 2016.
- Physicians on Surgeon General’s Letter on Opioid Epidemic: Survey Results. The Surgeon General issued an Open Letter on the Opioid Epidemic. We looked into how clinicians and other patient safety experts felt about it.
- The U.S. Opioid Epidemic In Numbers. Related, Advance for Nurses generated an infographic summarizing your responses.
- 12 Years of Event-Free Opioid Use. In 2016, St. Joseph’s/Candler Health System celebrated 12 years free from Serious Adverse Events related to Opioid-Induced Respiratory Depression since the implementation of its continuous monitoring program.
- 3 Ways to Make Opioids Safer. Peggy Lange, RT, Director of the Respiratory Care Department at St. Cloud Hospital, discussed the importance of setting alarm thresholds for each patient in this podcast.
- Drawn Curtains, Muted Alarms, And Diverted Attention Lead To Tragedy In The Postanesthesia Care Unit. Sadly, alarms on the monitoring equipment used to alert healthcare professionals to changes in the patient’s cardiac and respiratory status were muted in one tragic death of a 17-year-old.
- A New Tool to Predict Respiratory Failure: An Interview with Hiroshi Morimatsu, MD, Ph.D. Could this multi-parameter indicator help counter alarm fatigue?
Bloot Clots Safety
- New PPAHS Campaign Targeting Orthopedic Venous Thromboembolism. VTE is the third-most prevalent reason for readmission after surgery, and about 1 million hip and knee replacement surgeries happen each year in the U.S.
- Physician-Patient Alliance Partners with World Thrombosis Day. As part of our new campaign, we partnered with World Thrombosis Day in 2016. Looking forward to working together in 2017.
- Why Bundled Payments for Joint Replacement May Be Risky for Patients. We took a look at whether patients are receiving evidence-based or reimbursement-based care under the Bundled Payments model.
- Why All Medical Schools Must Incorporate Quality Improvement and Patient Safety into Their Curriculums. This position by Molly Siegel generated plenty of engagement on the Twittersphere and is a theme that cuts across all of our priority areas.
This week in #patientsafety, we look at the fact that opioid safety has yet again made the list of the ECRI Institute’s Top 10 Technology Hazards and we look at some key aspects of St. Joseph/Candler’s success in its continuous electronic monitoring program. From around the web, we share a video explaining how opioids cause harm and how their overprescription leads to drugs piling up in cupboards at home. We also share a story of a mother who died from blood clots – the coroner says her death was preventable.
Opioid Safety is again an ECRI Top-10 Health Technology Hazards for 2017. This is bittersweet. Bitter, because this problem is a major epidemic that has been going on for too long; sweet, because at least the topic is getting the attention it deserves.
Preventing Opioid-Related Adverse Events with Capnography. Continuous electronic monitoring has helped reduce serious adverse events related to opioid-induced respiratory depression at St. Joseph/Candler.
From Around the Web:
How the powerful opioid fentanyl kills. A video from the CBC explains how opioids work, and how they cause harm. Great for explaining the opioid epidemic to a lay audience.
Unused Opioids Pile Up in Medicine Cabinets, While Overprescribing Contributes to National Epidemic. Researchers at Johns Hopkins University School of Medicine, Baltimore, have found that health care providers dispense far more medicine than is necessary to treat pain after pediatric outpatient surgery.
Mum who died of blood clots two weeks after giving birth could have been saved, finds coroner. Marie Tompkins died from a blood clot. The coroner says the doctor failed to refer her to a scan that could have detected it.
PPAHS will be beginning a new #patientsafety campaign to develop practical solutions to help assess and prevent venous thromboembolism (VTE) in patients undergoing orthopedic procedures, particularly total knee and hip replacement. More commonly known as blood clots, VTE consists of both deep vein thrombosis (DVT) and pulmonary embolisms (PE) .
In the past, we have focused on the issue of VTE regarding maternal patients and stroke patients. In collaboration with panels of international health experts, PPAHS has developed the OB VTE Safety Recommendations and the Stroke VTE Safety Recommendations (both of which are free resources on our website). Members of the panel included:
- Atul Gawande, MD, MPH (Brigham and Women’s Hospital)
- Peter J. Pronovost, MD, PhD, FCCM (Johns Hopkins Medicine)
- Mark Alberts, MD, FAHA (Southwestern Medical Center)
- Irene Katzan, MD, MS (Cleveland Clinic)
- William M. Callaghan, MD, MPH (CDC)
- Frank Federico, RPh (Patient Safety Advisory Group, The Joint Commission)
- Mary D’Alton, MD (Columbia University Medical Center)
According to the CDC, VTE is estimated to affect 900,000 Americans annually. It is a preventable, hospital-acquired condition that is responsible for 100,000 deaths each year. The US Department of Health & Human Services (HHS) has also issued a statement identifying venous thromboembolism as the third most prevalent factor accounting for readmission 30-days after surgery (6.3%).
Hip and knee replacement operations are among the most commonly performed procedures in the U.S. About 1 million of these procedures are performed each year (for more on prevalence, see the study by Hilal Maradit-Kremers, MD, MSc et al, “Prevalence of Total Hip (THA) and Total Knee (TKA) Arthroplasty in the United States”). The 30-day readmission rate following hip and knee replacement is 4.3% and 3.9% respectively, with the readmission rate rising to 7.8% 90-days after surgery.
Join us in our fight to prevent orthopedic venous thromboembolism (VTE).
Over the next few months, we will be putting together an expert patient safety panel on orthopedic VTE to advise and help answer healthcare reporters’ questions, looking for interviewees for Patient Safety Podcasts (such as the series created in collaboration with the Society of Hospital Medicine), and for guest contributions to our blog.