Venous Thromboembolism Prophylaxis in the Nursing Home: To Do or Not To Do?

Venous thromboembolism risk screening, training and provider awareness in Australian residential aged care facilities

“…This study showed that in the absence of a government‐regulated protocol for VTE risk screening, aged care facilities have not developed or adopted protocols around VTE prevention and risk stratification. The absence of a specifically designed tool for the aged care population may be a factor in the lack of an implemented protocol (Choi & Hector, 2012; Dharmarajan & Norkus, 2013).…”

“…For example, the 2008 multinational audit of acute hospital care found 51.8% of hospitalised patients were at risk for VTE, and up to 59% of patients received adequate prophylaxis (Cohen et al, 2008). In the US, the incidence of VTE in Kansas nursing homes was defined as 13 per 1000 residents (Gomes et al, 2003); others have reported 1 in 25 nursing home residents have a diagnosis of VTE on admission, and a post‐admission incidence of 3.63 per 100 person‐years (Reardon et al, 2013), and prophylaxis in 85% of admissions (Dharmarajan & Norkus, 2013). Rates of VTE prophylaxis and sustained VTE incident reduction are shown to increase through staff education and systemic protocol implementation (Duff et al, 2013; Gallagher et al, 2009; Yates et al, 2014).…”

“…However, limited guidance concerning the continuity of care for patients is provided at discharge. There are no dedicated policy directives or risk assessment tools available for out‐patient services and residential aged care facilities (Choi & Hector, 2012; Dharmarajan & Norkus, 2013), despite VTE being globally recognised as a major patient safety issue and the documented heightened risk in aged care facility residents (Wickham et al, 2012). In the initial scoping for this study, the NSW Health Clinical Excellence Commission was contacted for comment, and responded “ Unfortunately we do not have a dedicated tool for nursing homes as we are primarily focused on supporting NSW hospitals in addressing VTE risk.…”

Venous Thromboembolism (VTE) Incidence and VTE-Associated Survival among Olmsted County Residents of Local Nursing Homes

“…[23,44,45] Autopsy rates are lower for NH residents; cognitive impairment, communication difficulties, competing co-morbidity, and/or immobility, each of which can impede symptom recognition, are higher. [5,12,46] Higher fall risk, medication use, and co-morbidity contribute to adverse consequences from anticoagulation[10,11] and may impact motivation for confirmatory testing. [47]…”

“…[2,3,38,50] These characteristics are also associated with risk of adverse outcomes from VTE prophylaxis. [10] Answers to important questions regarding trade-offs between these competing risks necessitate knowledge of the actual burden of VTE among NH residents. [9,13] Published estimates of NHVTE incidence and associated mortality are few, highly variable, and limited by available resources.…”