Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Misty Evans, DNP, APRN, CPNP-AC
• Committee Member Name & Credentials:
  Christin Diller, DNP, MSN

DNP Project Abstract

Increasing Post Thrombotic Syndrome Screening and Documentation in Pediatric Patients with Extremity Associated Deep Vein Thrombosis

Purpose
Post thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) impacting patient outcomes and quality of life. The modified villalta scale (MVS) is one of the PTS screening tools approved for use in the pediatric population to determine the severity of PTS. To improve outcomes in patients with DVT, we implemented a standardized process for PTS screening to increase the number of pediatric patients screened for PTS at a large pediatric hematology center from 0% to 80% over a 6-week period.

Methods
A quality improvement (QI) project design was used to implement the use of the MVS tool for patients with extremity related DVT diagnosed at least 6 months prior to office visit. Eligible patients were identified via chart review. Providers received PTS education, PTS resources, and weekly reminders to facilitate PTS screening in the electronic health record (EHR) via a PTS flowsheet containing the MVS screening criteria.

Results
Seventy-five patients aged 2 months – 24 years with extremity related DVT were scheduled for follow up visit during a 6-week period. Forty-five (60%) patients were due for PTS screening. Sixteen patients did not show to their clinic visit. Of the 29 patients due for PTS screening and present for their clinic visit, 62% (18/29) were screened for PTS. Mild to moderate PTS was detected in 66.7% (12/18) patients screened.

Implications for Practice
A missed PTS diagnosis or delayed treatment can lead to severe symptoms, worsening quality of life and invasive interventions that may otherwise be prevented with early recognition. Additionally, PTS is a clinical diagnosis that is confirmed via screening instruments such as the MVS. In this study, the implementation of the MVS increased the number of pediatric patients identified with PTS, a step toward improving outcomes of patients with DVT.