Institute for Healthcare Improvement (IHI) Perinatal Improvement Community Special Webinar "VENOUS THROMBOEMBOLISM (VTE) SAFETY RECOMMENDATIONS: TARGETING MATERNAL PATIENTS” January 22, 2014 IHI Perinatal Improvement Community in continuous existence since 2005
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Institute for Healthcare Improvement (IHI) · PDF fileInstitute for Healthcare Improvement (IHI) Perinatal Improvement Community Special Webinar "VENOUS THROMBOEMBOLISM (VTE)
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“These statistics may represent a conservative estimate of the problem. Why? Not all pregnancy-related deaths are accurately identified and reported. Hence, pregnancy-related deaths identified at the national level likely undercount the true number.”
William M. Callaghan, MD, MPH Chief, Maternal and Infant Health Branch
Division of Reproductive HealthNational Center for Chronic Disease Prevention and
Health Promotion Centers for Disease Control and Prevention
US Maternal Death Rate Compared to Other Countrieshttps://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html
US Maternal Death Rate Compared to Other Countries
The United States has a higher ratio of maternal deaths than at least 40 other countries, even though it spends more money per capita for maternity care than any other:1
•Venous thromboembolism costs the health care system more than $1.5 billion/year2
•Cost of managing an initial episode:2-deep vein thrombosis $7,712-$10,804 (est.)-pulmonary embolism $9,566-$16,644 (est.)
US Spending More, Getting Poorer Results
1. Ina May Gaskin, CPM, MA, “Maternal Death in the United States: A Problem Solved or a Problem Ignored?” Journal of Perinatal Education, 2008 Spring; 17(2): 9–13
2. Dobesh PP (2009) “Economic burden of venous thromboembolism in hospitalized patients.” Pharmacotherapy 29 (8): 943-53
Why Focus on VTE Pregnancy is a major risk factor for developing venous thrombosis and pulmonary embolism, especially following cesarean delivery and up to one month post partum.1“For pregnant women, the risks of VTE is 4-5 times higher than women who are not pregnant. Moreover, this risk is at least twice as much following cesarean delivery.” 2
Dr. Andra James Professor of Obstetrics & Gynecology,
Division of Maternal Fetal MedicineUniversity of Virginia School of Medicine
1. “Pregnancy-Related Mortality Surveillance” – Centers for Disease Control & Prevention, Feb. 21, 20132. http://ppahs.org/2013/05/02/preventing-death-following-cesarean-delivery/
VTE Risk for Maternal Patients
To ensure VTE Prevention is maximally used, harm reduction strategies should be used:
•consistently by clinicians •effectively with hand off communications
One Patient is One Too Many: The True Reason for OB VTE Prevention
Amber Scott: •On May 22, 2012, husband came home from work and found her unresponsive. •After determining that Amber had a blood clot in her brain, doctors performed an emergency caesarian section.
Although bed rest and hydration have been recommended to women with symptoms of preterm labor to prevent preterm delivery, these measures have not been shown to be effective for the prevention of preterm birth and should not be routinely recommended. Furthermore, the potential harm, including venous thromboembolism, bone demineralization, and deconditioning, and the negative effects, such as loss of employment, should not be underestimated.
Management of preterm labor. ACOG Practice bulletin 43. May 2003
PPAHS VTE Checklist Group: Health Expert PanelRose Mary Ainsworth, RN, MSN Mother/Baby UnitHuntsville Hospital for Women and ChildrenRichard Berkowitz, MD Quality Assurance DirectorColumbia University Medical CenterWilliam M. Callaghan, MD, MPH Chief, Maternal & Infant Health Branch Division of Reproductive Health National Center Centers for Disease Control and PreventionPeter Cherouny, MD Lead Faculty, Perinatal Community, Institute for Healthcare ImprovementNancy Chescheir, MDClinical Professor, Maternal-Fetal MedicineObstetrics and Gynecology,UNC School of MedicineSteven Clark, MD Medical Director, Women & Newborns Clinical ServicesHospital Corporation of AmericaMichèle G. Curtis, MD, MPH, MML CeeShell Consultingeditor of “Glass’ Office Gynecology”Raiyomand Dalal, FRANZCOG, MD, DNB, FCPS, DGO, DFP, MNAMSSenior LecturerSchool of Medicine, University of Western SydneyMary D’Alton, MD Chair, Department of Obstetrics & GynecologyMaternal-Fetal MedicineColumbia University Medical CenterLisa J. Enslow, MSN, RN-BC Nurse EducatorWomen's Health and Ambulatory Care ServicesHartford HospitalFrank Federico, RPh Patient Safety Advisory Group, The Joint CommissionExecutive Director, Institute for Healthcare Improvement
Sue Gullo, MS, RN Director, Perinatal Improvement CommunityInstitute for Healthcare ImprovementRoy Jackson, MD, B.Sc., MB.BCh., F.R.C.SSouthern Health CentreAndra James, MD John M. Nokes Professor of Obstetrics & GynecologyDivision of Maternal-Fetal MedicineUniversity of VirginiaBetty Janey Project Manager, Perinatal CommunityInstitute for Healthcare Improvement)Deborah Karsnitz, DNP, CNM, FACNM Nurse Educator, Frontier Nursing UniversityJohn Keats, MDPresident and Medical Director, California HealthFirst Physiciansmember, ACOG’s Patient Safety & Quality Improvement CommitteeColleen Lee MS, RN Maternal/Perinatal Patient Safety OfficerMontefiore Medical Center Michael Paidas, MD Co-Director, Yale Women and Children’s Center for Blood DisordersDepartment of Obstetrics, Gynecology and Reproductive Sciences Yale University School of MedicineJody PaxtonCoordinator, Statewide Intensive Care Clinical NetworkDepartment of Health, Queensland, AustraliaJanet N. Press, RNC, MS, CT Perinatal/Obstetrical CoordinatorC.N.Y.Regional Perinatal ProgramPerinatal Bereavement Services CoordinatorCrouse HospitalPeter Pronovost, MD, PhD, FCCMProfessor, Depts. of Anesthesiology/Critical Care Medicine & SurgeryThe Johns Hopkins University School of Medicine Richard Smiley, MD Chief, Obstetric AnesthesiaColumbia University Medical Center
“Ensuring the identification of pregnant women at-risk for VTE and applying measures to reduce VTE risks would assist in reducing blood clots, particularly for women following cesarean delivery.”
Dr. John Keats (ex-officio member of ACOG’s Patient
Safety and Quality Improvement Committee)
Simple, Cost-Effective Solutions: Easily Adopted and Ensures Maximal VTE Prevention
“Fortunately, risk factors for VTE can be reduced by simple and cost-effective measures, such as fitting inflatable compression devices on a woman’s legs before cesarean delivery and using inflatable compression sleeves until the woman is able to walk after delivery.”
Dr. Andra James (Professor of Obstetrics & Gynecology,
Division of Maternal Fetal Medicine, University of Virginia School of Medicine)