Improving Nursing Processes to Reduce Hospital-Acquired Venous Thromboembolism in Adult Surgical Patients

INTRODUCTION Hospital-acquired venous thromboembolism (VTE) is a preventable outcome that can increase morbidity and mortality. This quality improvement (QI) project aimed to evaluate and improve the nursing prophylaxis processes to reduce the VTE outcome. The project was implemented in a Level I Trauma Center in the Texas Medical Center, Houston, Texas. METHODOLOGY The QI project was structured using the Lean Six Sigma methodology. Data was collected and analyzed from reports built within the electronic medical record (EMR). A multidisciplinary team evaluated the current state of clinical practice and the electronic workflow for mechanical VTE prophylaxis. The team worked to redesign the sequential compression device pump acquisition process and the Best Practice Advisory alert to nursing within the EMR to improve nursing prophylaxis interventions. Changes were implemented in phases and measured through Plan-Do-Study-Act.cycles. RESULTS The overall VTE rate was reduced by 43.89%. The turnaround median time for sequential compression device application was improved by 45%, and the nurse response to an electronic alert was increased by 349.5%. IMPLICATIONS A multidisciplinary approach that includes the front-line subject matter experts is critical to evaluating where opportunities to improve exist within a process. Leveraging the electronic medical record to pull reports of process metrics optimizes the team to make data-driven improvements. Executive leadership commitment is essential in prioritizing improvements within the electronic medical record. Utilizing an existing governing body expedites decision-making on targeted solutions. Future quality improvement projects are needed to evaluate additional solutions to sustain the electronic workflow’s support of clinical practice.