Nursing Intervention Improves VTE Prophylaxis in GYN Onc Unit

BOSTON—Hospitalized oncology patients are at particular risk for acute venous thromboembolism (VTE); however, more often than not, a standard for VTE prophylaxis does not exist, according to Jerelyn Osoria, RN, OCN, of Memorial Sloan-Kettering Cancer Center. Ms. Osoria reported at the Oncology Nursing Society 31st Annual Congress (abstract 113) that an electronic medical orders system and better nursing documentation have helped improve this situation at her institution's Gynecology (GYN) oncology inpatient nursing unit.

Preliminary data showed that 38% of GYN medical oncology patients and 8% of GYN surgical oncology patients were being admitted without admission VTE prophylaxis orders. The standard regimen includes sequential compression devices (SCD) with or without low-molecular-weight heparin.

Hoping that "ongoing review of practice patterns with feedback of data to clinical staff may increase compliance with established guidelines for VTE prevention," MSKCC put together an interdisciplinary VTE prophylaxis committee, which initiated a computerized order entry set that contains the standard guidelines for VTE prevention. Doctors and nurses on the GYN surgery and medical oncology services were educated about the importance of VTE prevention and given regular feedback on their service's compliance.

"Daily floor rounds were performed to assure the placement of SCDs at the bedside, with flow sheet documentation of implementation," Ms. Osoria said. Oncology nursing staff had monthly education sessions that included feedback on compliance data.

Early evaluations indicate that this effort has increased the use of VTE prophylaxis in the GYN medical oncology service, Ms. Osoria said. Rates of nursing compliance are up on both services, and during the month of unit-based audit and feedback, the percentage of patients without VTE orders dropped from 38% to 13% on the GYN medical oncology service and remained at about 8% on the GYN surgical oncology service.

Ms. Osoria told ONI that an important part of the program is the use of electronic orders. "When launched hospital wide, the medical orders system will provide a mandatory field within the admission order sets. This will ensure that VTE prophylaxis is addressed on an individual patient level," she said. "We also standardized the nursing documentation on the unit to increase compliance with VTE prophylaxis."

One of the barriers to improving VTE prophylaxis rates in oncology is lack of standardization. "As a result of research findings and the National Comprehensive Cancer Network guidelines, our VTE prophylaxis committee was able to formulate hospital standards that provide treatment options as well as information on comorbidities for our unique patient population," Ms. Osoria commented.