VTE Prophylaxis Order Form

Key Advantages Using this Tool:

1. Train staff regarding VTE risk factors
2. Train staff regarding appropriate interventions for VTE prophylaxis
3. Establish a mechanism for addressing VTE prophylaxis in all adult patients admitted to our hospital

Tips on Using this Tool:

1. Educate nursing staff on risk factors and exclusion criteria for VTE prophylaxis prior to implementation
2. Educate/notify physician staff prior to implementation
3. Utilize medical records and pharmacy to audit use of anticoagulant agents for VTE prophylaxis as a means of auditing use

Important Pitfalls:

1. Verification of compliance
2. Ensuring acceptance among all providers

Resources Used to Develop Tool:

1. William H. Geerts, John A. Heit, G. Patrick Clagett, Graham F. Pineo, Clifford W. Colwell, Frederick A. Anderson, Jr., and H. Brownell Wheeler, Prevention of Venous Thromboembolism, Chest 2001: 119: 132S-175S.
2. Coon, WW (1984) VTE: prevalence, risk factors, and prevention. Clin Chest Med 5, 391-401
3. Carter, CJ (1994) The natural history and epidemiology of venous thrombosis. Prog Cardiovasc Dis 36,423-438
4. Gallus, AS, Salzman, EW, Hirsh, J (1994) Prevention of VTE. Colman, RW Hirsh, J Marder, VJet al eds. Hemostasis and thrombosis: basic principles and clinical practice 3rd ed. ,1331-1345 JB Lippincott Philadelphia, PA.
5. Hansson, P-O, Eriksson, H, Welin, L, et al (1999) Smoking and abdominal obesity. Risk factors for VTE among middle-aged men: "The Study of Men Born in 1913." Arch Intern Med 159,1886-1890
6. Rosendaal, FR (1999) Risk factors for venous thrombotic disease. Thromb Haemost 82,610-619
7. Grady, D, Wenger, NK, Herrington, D, et al, (2000) Postmenopausal hormone therapy increases risk for venous thromboembolic disease: the Heart and Estrogen/progestin Replacement Study Ann Intern Med 132,689-696
8. Local resources: Carillion Medical Center, Committee on Anticoagulation, Performance Improvement Committees of Departments of Medicine and Surgery

View the Carillion Medical Center Venous Thromboembolic (VTE) Prophylaxis Order Form