Blood Clots

March is Blood Clot Awareness Month

Blood Clot Awareness Month logo

March is Blood Clot Awareness Month.

Spearheaded by the National Blood Clot Alliance, #BCAM is a time for patients, caregivers, healthcare professionals, and advocates to draw attention to deep vein thrombosis and venous thromboembolism.

According to the National Blood Clot Alliance:

“Blood clots do not discriminate. They can and do affect anyone from children to senior citizens, from professional athletes to mothers, women and men – no one is immune. Tragically, roughly 274 lives are lost each day in the U.S. simply because public awareness about life-threatening blood clots is so low.”

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.

Blood Clots & Pregnant Women: A Doctor’s Perspective

The first resource we would like to share is a podcast interview with Peter Cherouny, M.D., Emeritus Professor, Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Chair and Lead Faculty: IHI Perinatal Improvement Community.

In this podcast, Dr. Cherouny outlines reasons why the maternal death rate is climbing and looks at the possible solutions.

Watch the podcast with Dr. Cherouny here.

Blood Clots & Pregnant Women: A Nurse’s Perspective

The second resource is a podcast interview with Colleen Lee MS, RN (Maternal/Perinatal Patient Safety Officer, Montefiore Medical Center).

Ms. Lee discusses the heightened risk of blood clots in pregnant women, and what can be done about it.

Watch the podcast with Ms. Lee here.

Free Resources: Blood Clot Safety Recommendations

PPAHS has assembled a team of patient safety experts to develop free clinical tools to help keep patients safe from developing blood clots.

We present two sets of concise recommendations that will help you reduce the risk of venous thromboembolism (VTE) in OB/GYN and stroke patients.

Download them here:

  1. OB VTE Safety Recommendations
  2. Stroke VTE Safety Recommendations
Blood Clots, Patient Safety

Key Aspects of the PPAHS Orthopedic VTE Report

The Physician-Patient Alliance for Health & Safety (PPAHS) released findings on practical solutions to prevent venous thromboembolism (VTE) in patients undergoing hip and knee replacement.

According to Michael Wong, JD, Founder and Executive Director of PPAHS:

“The survey indicates that awareness of the risks of VTE following orthopedic surgery are high.  Patients go through at least one assessment screening for risk of VTE, with an average of two times.

“Of note is the level to which prescription for mechanical prophylaxis, such as intermittent pneumatic compression device, drops following discharge; from 78% prior to surgery to 43% prior to discharge. An analysis of the data shows that eligibility for such methods under Medicare Part B could be a key driver in this pattern, with respondents indicating that they would be 34% more likely to prescribe mechanical prophylaxis for their patients if it were covered by Medicare Part B.

“It is clear that the lack of coverage by the CMS has restricted physician options in preventing VTE upon discharge. Nearly seven in ten respondents indicated that they believed that the lack of coverage for mechanical prophylaxis after discharge under Medicare Part B was not in the best interest of the patient. This indicates a strong call from physicians to have the ability to prescribe the appropriate method for preventing VTE in their patients on an individual basis.”

Download the full report here.

Hip and knee replacement surgeries are among the most commonly performed procedures in the US. About 1 million of these procedures are performed each year.

The 30-day readmission rate following hip and knee replacement is 4.3% and 3.9% respectively. The readmission rate rises to 7.8% 90-days after surgery.

VTE Assessment and Action

Assessment for VTE occurs prior to surgery (66%), upon admission (53%), and prior discharge (32%). Respondents were able to indicate whether patients were assessed at multiple touchpoints. Below is an analysis of at which touchpoints patients are assessed for VTE.

Response Breakdown for Orthopedic VTE Survey

With respect to prescription rates of pharmacologic and mechanical DVT prophylaxis, the survey found that prescription rates for mechanical prophylaxis drops dramatically upon patient discharge, to 43% (compared to 78% for pharmacologic prophylaxis).

A column graph showing actions to prevent deep vein thrombosis

Effect of Reimbursement Status on Prescriptions

Findings showed that respondents would be 34% more likely to prescribe mechanical prophylaxis such as intermittent pneumatic compression devices (IPCD) if it were reimbursable under Medicare Part B.

Column graph showing likelihood of mechanical prophylaxis.

To calculate this percentage, results were calculated using an average weighting, where w = weight of answer choice and x = response count for answer choice.

The formula used to calculate percentage of likelihood. (x1w1 + x2w2 + ... +xnwn) / Total

The vast majority of respondents (68%) believed that the omission of Medicare Part B coverage for mechanical prophylaxis, such as IPCD, was not in the best interest of patient safety.

A pie chart showing that 68% of respondents felt the current policy of Medicare Part B is not in the best interest of the patient.

Another question was developed to understand if perceived patient compliance also plays a role in current prescription practices. The findings show that respondents believe patients are more adherent to pharmacological prescriptions compared to mechanical prophylaxis (48% increase in perceived likelihood using the same average weighting described above).

A column chart showing perception of likelihood of patient compliance post-discharge

Key Tools to Treat & Assess VTE

The research also showed a clear need for concise recommendations available for clinicians outlining evidence-driven best practices and guidelines (71%). Respondents indicated that risk assessment tool needs to be developed to improve screening for risk of VTE in key patient segments (68.3%).

Helping Patients with VTE Prevention Legend

  1. Concise recommendations summarizing current best practices, literature, guidelines and recommendations.
  2. Risk assessment tool
  3. Articles by experts highlighting examples of best practices
  4. Podcasts by experts highlighting examples of best practices
  5. Articles by experts on the prevention of VTE
  6. Podcasts by experts on the prevention of VTE
  7. Other

The survey gathered 41 respondents from across the United States and targeted patient safety experts in orthopedics. The majority of respondents indicated that they were either physicians (42.5%) or nurses (32.5%).  Those who elected to identify themselves as “Other” largely fell within four self-identified professions: nurse practitioners, physical therapists, program managers, and pharmacists. About 3 in 5 respondents indicated that their primary work setting was in Orthopedics.

PPAHS has brought together panels of health experts to develop free clinical tools including the OB VTE Safety Recommendations and the Stroke VTE Safety Recommendations.

Blood Clots, Patient Safety

Orthopedic VTE Safety Report Now Available

The Physician-Patient Alliance for Health & Safety (PPAHS) released findings on practical solutions to prevent venous thromboembolism (VTE) in patients undergoing hip and knee replacement.

The survey gathered 41 respondents from across the United States and targeted experts in orthopedics. The majority of respondents indicated that they were either physicians (42.5%) or nurses (32.5%). Those who elected to identify themselves as “Other” largely fell within four self-identified professions: nurse practitioners, physical therapists, program managers, and pharmacists. About 3 in 5 respondents indicated that their primary work setting was in Orthopedics.

According to Michael Wong, JD, Founder and Executive Director of PPAHS:

“The survey indicates that awareness of the risks of VTE following orthopedic surgery are high. Patients go through at least one assessment screening for risk of VTE, with an average of two times. The clinical outcome goal should be targeted at 100% compliance with VTE risk assessment on admission (to establish a baseline) and at multiple points along the patient’s continuum of care until discharge.

“Of note is the level to which prescription for mechanical prophylaxis, such as intermittent pneumatic compression device, drops following discharge; from 78% prior to surgery to 43% prior to discharge. An analysis of the data shows that eligibility for such methods under Medicare Part B could be a key driver in this pattern, with respondents indicating that they would be 34% more likely to prescribe mechanical prophylaxis for their patients if it were covered by Medicare Part B.

“It is clear that the lack of coverage by the CMS has restricted physician options in preventing VTE upon discharge. Nearly seven in ten respondents indicated that they believed that the lack of coverage for mechanical prophylaxis after discharge under Medicare Part B was not in the best interest of the patient. This indicates a strong call from physicians and their patients is needed to have the ability to prescribe the appropriate method for preventing VTE in their patients on an individual basis.”

Download the full report here.

Hip and knee replacement surgeries are among the most commonly performed procedures in the US. About 1 million of these procedures are performed each year.

The 30-day readmission rate following hip and knee replacement is 4.3% and 3.9% respectively. The readmission rate rises to 7.8% 90-days after surgery.

In the past, PPAHS has brought together panels of health experts to develop free clinical tools regarding VTE, including the OB VTE Safety Recommendations and the Stroke VTE Safety Recommendations.

 

Blood Clots, Hospital Acquired Conditions

Why Bundled Payments for Joint Replacement May Be Risky for Patients

The following is an excerpt of an article written by Michael Wong, JD, Executive Director of PPAHS and Lynn Razzano, RN, MSN, ONCC, Clinical Nurse Consultant at PPAHS.  It was first appeared on The Doctor Weighs In on November 18, 2016.  To read the full article, please click here.

CMS-bundled-payments

According to the Centers for Medicare & Medicaid Services (CMS), hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries. In 2014, there were more than 400,000 procedures, costing more than $7 billion for the hospitalizations. CMS says that there is little consistency across providers in terms of the quality and cost of care for these procedures.

With an aim to improve the consistency of the quality and cost of care among providers,  CMS has introduced a new payment model, Comprehensive Care for Joint Replacement (CJR), in April 2016, using a concept known as bundled payments.

A significant aspect of this new model is that it contains exceptions to what will be reimbursed—exceptions that could prove potentially harmful to patients recovering from hip and knee replacements. Reconsidering these exceptions could go a long way in improving patient safety, reducing the number of readmissions, and reducing the cost of care for patients undergoing hip and knee replacement. Read More

Blood Clots, Patient Safety

Physician-Patient Alliance Partners with World Thrombosis Day

Good news!

The Physician-Patient Alliance for Health & Safety has been invited to become a partner of World Thrombosis Day, an international multi-organizational campaign devoted to increasing global awareness about thrombosis, including its causes, risk factors, signs/symptoms, evidence-based prevention and treatments.

World Thrombosis Day aims to highlight the need for action on thrombosis, specifically underscoring the unrecognized threat and serious consequences (morbidity and mortality) related to venous thromboembolism (VTE).

Know Thrombosis Hospital Associated Infographic
Read More

Blood Clots

VTE Prophylaxis is a Must for Preventing VTE Readmissions in Orthopedic Patients: AAOS & ACCP Guidelines

The guidelines for preventing VTE after total joint arthroplasty (such as, knee and hip replacement) by the Academy of Orthopaedic Surgeons and American College of Chest Physicians are unanimous – both pharmacological and mechanical prophylaxis are needed.

x-ray-scanThe AAOS recommends the use of pharmacological and/or mechanical compression devices for both total hip arthroplasty (THA) and total knee replacement (TKA) patients who are not at an elevated risk for VTE or bleeding, as well as for patients with a known bleeding disorder and/or active liver disease.
Read More

Blood Clots

New PPAHS Campaign Targeting Orthopedic Venous Thromboembolism

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) . Read More

Blood Clots

Hypercoagulation and Blood Clots in Women: A Patient Safety Concern?

By Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

Editor’s Note: This is the first post in what we hope will become a regular series of opinion pieces which ask our readers to comment on what could be considered controversial. Maternal patients are at risk for venous thromboembolism (VTE, commonly referred to as blood clots), which has been identified as a patient safety issue. In this post, the question asked is whether the recent deaths of young women due to blood clots from taking birth control pills is also a patient safety issue. 

Being pregnant increases the risks of blood clots. “For pregnant women, the risk of VTE is 4-5 times higher than women who are not pregnant,” says Andra James, MD (Professor of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Virginia School of Medicine). “Moreover, this risk is at least twice as much following cesarean delivery.”

Hypercoagulation during pregnancy is likely an adaptive mechanism to reduce the risk of hemorrhage during and after the delivery process. Read More

Blood Clots, Opioid Safety, Patient Safety, Respiratory Compromise

3 Ways To Improve Safety for Patient Safety Awareness Week

This week (March 13-19) is Patient Safety Awareness Week.

The National Patient Safety Foundation says the campaign is “designed to spark dialogue and promote action to improve the safety of the health care system for patients and the workforce.” Read More