VTE prophylaxsis

laura.bohls@prairielakes.com

This isn't a CDI topic, but like everyone our department gets involved in all areas I was wondering if anyone out there has a good resource for VTE prophylaxsis for core measures. What I am looking for is the guidelines of what meets for VTE prophylaxsis. I have looked and haven't been able to find it myself (at least that I can understand.)

Thanks,
Laura Bohls, RN CDS
Prairie Lakes Healthcare System

catladyrn

The measures are found on Quality Net, and they can be hard to understand, but you still have to reference them in order to capture the right diagnoses and the right interventions.

I'm attaching a cheat sheet of guidelines that I produced at the beginning of the year. Some of the measures referenced have been retired or are considered voluntary for CMS, so only look at what your facility is tracking. VTE starts on page 5.

Renee

Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System

evanspx@sutterhealth.org

Renee

Thanks for sharing this excellent summation of a very detailed topic. Do you have anything similar for Readmissions?

Paul



Paul Evans, RHIA, CCS, CCS-P, CCDS
 
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell:  415.412.9421

laura.bohls@prairielakes.com

Thank you so much Renee your cheat sheets; they are a great quick reference. If I might ask your help with interpreting. Where our issue comes from is patients admitted with PE/DVT on a heparin gtt. Our quality director is telling us the heparin gtt doesn't count. As I read the guideline what we need is the heparin gtt and patient started on Coumadin correct? And, in the case of patients admitted for some other diagnosis if they currently take Coumadin prior to admission and are therapeutic we are meeting the core measure correct? I'm sorry for all the questions but it's become quite an issue as of late and our quality director sometimes pushes overkill to make sure we don't fall out on any of the measures, but it causes friction with the MDs.

Thanks

Laura Bohls, RN
Clinical Documentation Specialist
605-882-5454

catladyrn

I'm a bit confused on the issue you state. I don't know why heparin would not be acceptable. The measures require that patients with confirmed PE or DVT be on overlap therapy with a parenteral anticoagulant and Coumadin for five days unless there is a documented reason. If you are giving the Coumadin and the overlap therapy parameters are met it doesn't matter if they were already on it. For other patients, Coumadin meets the VTE prophylaxis requirement for pharmacological prophylaxis regardless of when they started taking it.

I'm not responsible for core measures as of March so maybe things have changed but that's how I remember it.

Renee

Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System

laura.bohls@prairielakes.com

I'm confused too Renee, that's why I was asking for your help I think our quality director is wrong when she says heparin doesn't qualify. And, our quality director is very black and white. Once she decides something it's very hard to convince her she might have read something wrong. I'll do a little more digging before I talk to her about it. Thank you so much for the information you've shared. It's been a great help.

Laura Bohls, RN
Clinical Documentation Specialist
605-882-5454

annnd2009@gmail.com

I did core measures a year ago+ and it's starting to ring a bell where iv Hampton didn't count but sub q did??? Not sure but kind of recall something that seemed odd...

One of the most interesting things as drgs and core measures are CMS. The rules are hard to pin down in coding and very specific with data dictionary and very specific drug tables. You are always able to query QNET when challenging situations occur.

cnolan@swgeneral.com

Attached is a VTE Prophylaxis Inclusion Table from the Ohio Coverdell Stroke Program; howver last updated 2013.
Hope this helps.