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Venous Thromboembolism (VTE) Prophylaxis Orders

By Andrea Owens,2014-06-05 18:38
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Venous Thromboembolism (VTE) Prophylaxis Orders

     PLACE LABEL HERE VENOUS THROMBOEMBOLISM (VTE)

    PROPHYLAXIS ORDERS (Inpatient)

    The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

    Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

    1. No Pharmacologic or Mechanical VTE Prophylaxis needed:

    No pharmacologic or mechanical prophylaxis Low Risk Ambulate 3 times daily

    2. Pharmacologic VTE Prophylaxis:

     VTE pharmacologic prophylaxis has already been ordered;

     Patient is therapeutic on anticoagulant therapy, no additional orders Medical

     Lovenox (enoxaparin) 40 mg SQ daily at 1700 (30 mg if CrCl < 30 ml/min) Heparin 5,000 units SQ q 8 hrs (q 12 hrs if wt < 50 kg OR age > 75) Moderate to Contraindication: must use mechanical prophylaxis, indicate order below High Risk Active hemorrhage or high risk for bleeding (including post-procedural risk) Recent GI or GU hemorrhage < 1 month Thrombocytopenia, coagulopathy, history of Heparin Induced Thrombocytopenia (HIT)

     Recent head trauma, spinal cord injury, intracranial hemorrhage, or neoplasm

     Epidural or spinal catheter within past 6 hours or next 12 hours

     Uncontrolled systemic hypertension

     Patient/family refuses

     Other: ______________________________________________________________

     VTE pharmacologic prophylaxis has already been ordered;Surgical Patient is therapeutic on anticoagulant therapy, no additional orders

    Non-orthopedic Lovenox (enoxaparin) 40 mg SQ q 24 hrs, begin in AM on POD #1 (30 mg if CrCl < 30 ml/min) Moderate to Heparin 5,000 units SQ q 8 hrs q12 hrs begin in AM on POD #1

    High Risk Contraindication: must use mechanical prophylaxis, indicate order below Active bleeding/high risk for bleeding (including post-surgical or post-procedural risk) ; Hold enoxaparin Thrombocytopenia, coagulopathy, history of Heparin Induced Thrombocytopenia (HIT) until epidural has Head trauma, neurosurgery/spinal procedures been out for 12 hrs Epidural or spinal catheter within past 6 hrs or next 12 hrs ; Hold Heparin until Patient/family refuses epidural has been Other: _______________________________________________________________ out for 2 hrs

    Surgical ;See Orthopedic Post-op Orders for DVT prophylaxis.;Orthopedic

    3. Mechanical VTE Prophylaxis:

     VTE mechanical prophylaxis has already been ordered;Moderate to

     Sequential Compression Device (SCD) High Risk

     Contraindication, no additional orders

    Optional unless Known or Suspected DVT

     Severe Ischemic vascular disease contraindication to Local condition (gangrene, leg wounds, skin graft, cellulitis, amputee) pharmacologic Other: ____________________________________________________________ prophylaxis

______________ ___________________ _________________________________ __________

    Date Time Physician Signature PID Number *2-33058* FORM 2-33058 REV. 02/2013 WHITE: Medical Record CANARY: Pharmacy Page 1 of 2

    PLACE LABEL HERE VENOUS THROMBOEMBOLISM (VTE)

    PROPHYLAXIS ORDERS

    Venous Thromboembolism (VTE) Risk Factors Age > 50 years Prior History of VTE Active or chronic lung disease Myeloproliferative Disorder Impaired Mobility Obesity

    Dehydration Inflammatory bowel disease Known thrombophilic state CHF Active rheumatic disease Varicose veins/chronic stasis Active malignancy Sickle cell disease Recent post-partum w/immobility Hormonal replacement Estrogen based contraceptives Nephrotic syndrome Moderate to Major Surgery Central venous catheter Myocardial Infarction

    Risk Factor Guide for VTE in Hospitalized Medical Patients

    (Padua Prediction Score Risk Assessment Model CHEST, 2012)

    Risk Factor Points Active Cancer

    Patients with local or distant metastases and or in whom chemotherapy or radiotherapy has been performed in the past 6 3 months

    Previous VTE 3 With exclusion of superficial vein thrombosis

    Reduced Mobility 3 Anticipated bed rest w/ bathroom privileges because of patient limitations or Physician orders for at least 3 days Already known thrombophilic condition 3 Defects of antithrombin, protein C or S, factor V Leiden, antiphospholipid syndrome

    Recent (< 1 month) trauma or surgery 2 Elderly age (> 70 y) 1 Heart or Respiratory failure 1 Acute myocardial Infarction or ischemic stroke 1 Acute Infection or rheumatologic disorder 1 Obesity (BMI > 30) 1 Ongoing hormonal treatment 1 High risk for VTE is defined by a cumulative score equal or greater than 4. In those cases, pharmacologic prophylaxis is strongly recommended, unless contraindicated.

    Disclaimer:

    This chart is a guide only to help physicians assess VTE risk. It should not be used as a substitute for medical judgement.

    Risk Factor Guide for VTE in Hospitalized Surgical Patients

    LOW RISK MODERATE RISK HIGH RISK

     Ambulatory patient without additional All other patients not in LOW Elective major lower extremity arthroplasty VTE risk factors or HIGH Risk Category Hip, pelvic or severe lower extremity fractures Ambulatory patient with expected LOS Acute spinal cord injury with paresis < 2 days/minor surgery Multiple major trauma

     Abdominal or pelvic surgery for cancer Ambulation & Education LMWH or UFH/ SCD if neither LMWH (or therapeutic anticoagulation) AND SCD LMWH = Low Molecular Weight Heparin UFH = Unfractionated Heparin SCD = Sequential Compression Device HIT= Heparin Induced Thrombocytopenia

FORM 2-33058 REV. 02/2013 REFERENCE PAGE Page 2 of 2

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