Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Misty Evans DNP, CPNP-AC
 

 

DNP Project Abstract

Risky Business: Venous Thromboembolism Risk Screening in Pediatric Critical Care

Purpose
Implement a venous thromboembolism (VTE) risk screening protocol for patients >/= 13 years old presenting to the Pediatric Critical Care Unit (PCCU) from August 2022 - December 2022.

Increase VTE prophylaxis screening utilization from 0% within 48 hours of admission (January 2022-August 2022) to 50% within 48 hours of admission from August 2022 to December 2022 in the Pediatric Critical Care Unit at Vanderbilt for patients >/= 13 years old.

Methods
Utilized a Plan Do Study Act (PDSA) quality improvement model to implement a screening protocol for children (>/= 13 years old) admitted to the PCCU. Created functionality in EMR to document VTE risk factors and contraindications as well as integrate the VTE Risk Screening Protocol into the ordering of VTE prophylaxis for eligible patients.

Results
Screening frequency increased from 0% prior to the implementation of the VTE risk assessment protocol to 93% after PDSA Cycle 2. After PDSA Cycle 1, only 9.23% of eligible patients were screened within 48 hours of admission. After re-education and EMR documentation system adjustments, 93% of eligible patients were screened within 48 hours of admission after PDSA Cycle 2. VTE prophylaxis based on risk assessment increased from 50% of eligible patients in PDSA Cycle 1 with appropriate prophylaxis to 80% of eligible patients in PDSA Cycle 2 with appropriate prophylaxis.

Implications for Practice
The VTE Risk Assessment Protocol is a low-cost, effective tool to screen at-risk patients and encourage appropriate VTE prophylaxis ordering. EMR integration allowed for easy documentation and visual cues for reassessment. Frequent reassessments identified as a potential burden on ICU staff and subspecialty preference limited ordering of VTE prophylaxis. Moving forward, VTE prophylaxis screening will be integrated into a safety rounding tool in the ICU to increase compliance.