Intensive Care Unit Venous Thromboembolism Prophylaxis

This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)

Measure specifications are in the Public Domain

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This material contains SNOMED Clinical Terms(R) (SNOMED CT[C]) copyright 2004-2016 International Health Terminology Standards Development Organization. All rights reserved.

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

Encounter, Performed: Encounter Inpatient

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Approximately two-thirds of cases of Deep Vein Thrombosis (DVT) or Pulmonary Emboli (PE) are associated with recent hospitalization. This is consistent with the 2001 report by Agency for Healthcare Research and Quality (Shojania, et al., 2001). AHRQ reports that "the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety, by reducing the incidence of VTE."

Almost all hospitalized patients have at least one risk factor for Venous Thromboembolism (VTE), and approximately 40% have three or more risk factors. Without thromboprophylaxis, the incidence of objectively confirmed, hospital-acquired DVT is approximately 10% to 40% among medical or general surgical patients and 40% to 60% following major orthopedic surgery (Geerts et al., 2008).

Commonly, criteria for admission to the Intensive Care Unit (ICU) itself, puts patient's at an increased risk for developing VTE, and subsequent increased risk of morbidity from PE. Some risk factors are related to the acute illness present that allowed for the admission to the ICU unit, and some risk factors may be acquired during the ICU admission due to subsequent medical treatments, for example limitations of mobility, presence of central venous lines or mechanical ventilation and subsequent pharmacological paralysis.  Reports of DVT in the population of ICU patients vary in relation to the acuity of the illness in this population. DVT in ICU patients diagnosed with routine venography or Doppler ultrasound found ranges between 10% to 100%. Five studies prospectively screened patients who were not receiving thromboprophylaxis during their ICU stays. The rates of DVT using Fibrinogen Uptake Test, Doppler Ultrasound or venography ranged from 13 to 31% (Geerts et al., 2008).  It is essential for all ICUs to assess each patient upon admission to the ICU unit, a change in level of status, for the need for VTE prophylaxis due to the above increased development of risk factors (Geerts, et al., 2004).

Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.

Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for critically ill hospitalized patients for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease.  All intensive care  unit (ICU) patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.

Improvement noted as an increase in rate

Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008; 133:381S-453S.

Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):338S-400S.

Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2) (Supp):7S-47S.

Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-94S 

Shojania KG, Duncan BW, McDonald DM, et al. (Eds.). (2001). Making healthcare safer; A critical analysis of patient safety practices (Evidence Report/Technology Assessment No. 43). Prepared by the University of California at San Francisco-Stanford Evidenced-based Practice Center under Contract no. 290-97-0013 (AHRQ Publication NO.01-E058). Rockville, MD:Agency for Healthcare Research and Quality.

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The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project. An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.

TBD

Patients age 18 and older discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period

Patients directly admitted or transferred to ICU during the hospitalization

* Patients who have a hospital length of stay (LOS) less than 2 days
* Patients with comfort measures documented anytime between arrival and the day after ICU admission or transfer
* Patients with comfort measures documented by the day after surgery end date for surgeries that end the day of or the day after hospital admission
* Patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that end the day of or the day after ICU admission or transfer

Patients who received VTE prophylaxis: 

- the day of or the day after ICU admission (or transfer) 
- the day of or the day after surgery end date for surgeries that end the day of or the day after ICU admission (or transfer)

Patients who have documentation of a reason why no VTE prophylaxis was given:
- between arrival and ICU admission (for patients directly admitted as inpatients to the ICU)
- the day of or the day after ICU admission (or transfer)
- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission (or transfer)

Not Applicable

Patients with ICU LOS less than one day

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

eMeasure Venous Thromboembolism (eVTE)