Cardiovascular Guidelines1. *
ACS: Chest Pain and Acute Coronary Syndrome, Diagnosis and Treatment of (Guideline - 70 pages)
open here:
http://www.icsi.org/acs_acute_coronary_syndrome/acute_coronary_syndrome_and_chest_pain__diagnosis_and_treatment_of_2.htmlScope and Target Population:
Adults greater than age 18 years presenting with past or present symptoms of chest pain/discomfort and/or indications of acute coronary syndrome.
Clinical Highlights and Recommendations:
On initial contact with the health care system, high-risk patients need to be identified quickly and referred to an emergency department via the 911 system.
Patients whose chest pain symptoms are suggestive of serious illness need immediate assessment in a monitored area of the emergency department and early therapy to include an immediate EKG, intravenous access, oxygen, aspirin and other appropriate medical therapies.
Triage and management of patients with chest pain and unstable angina should be based on a validated risk assessment systems and clinical findings.
Patients with low-risk symptoms could be evaluated as outpatients.
Patients with high-risk features need to be identified quickly and treatment instituted in a timely fashion.
Thrombolysis should be instituted within 30 to 60 minutes of arrival, or angiogram/primary percutaneous coronary intervention should be performed within 90 minutes of arrival, with a target of less than 60 minutes.
Recommend use of the following medications: aspirin and clopidogrel (or clopidogrel alone if aspirin allergic) at admission. Avoid clopidogrel if cardiac surgery is anticipated. Use beta-blockers whenever possible and/or ACE inhibitors/angiotensin receptor blockers at 24 hours if stable, nitrates (when indicated), and statins whenever possible. Once the issue of surgery is clarified, consider the early use of a thienopyridine for those in whom percutaneous coronary intervention is planned.
Recommend appropriate use of cardiac rehabilitation postdischarge.
Priority Aims:
Increase the success of emergency intervention for patients with high-risk chest pain.
Minimize the delay in administering thrombolytics or percutaneous coronary intervention to patients with acute myocardial infarction.
Increase the timely initiation of treatment to reduce postinfarction mortality in patients with acute myocardial infarction.
Increase the percentage of patients with acute myocardial infarction who have used tobacco products within the past year who receive tobacco cessation advice and counseling during the hospital stay (The Joint Commission).
Increase the percentage of patients with acute myocardial infarction using appropriate cardiac rehabilitation postdischarge.
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2. *Antithrombotic Therapy Supplement (Guideline - 71 pages)
open here:
http://www.icsi.org/antithrombotic_therapy_supplement__guideline__14045/antithrombotic_therapy_supplement__guideline_.htmlScope and Target Population:This guideline supplement is targeted for any patient receiving antithrombotic therapy. Please refer to related ICSI guidelines for specific target populations.
Clinical Highlights and Recommendations:There are no circumstances under which patients absolutely should or should not receive anticoagulation therapy. Clinicians must consider the risks and benefits of anticoagulation therapy for a patient based upon the individual's risk for thrombosis if not treated weighed against the risk of bleeding if treated.
In the initial phase of treatment for patients with active thrombosis (such as acute deep vein thrombosis [DVT]) or high risk of thrombosis, immediate-acting anticoagulant agents (UFH/LMWH/fondaparinux) should be used concomitant with warfarin.
Loading doses of warfarin should be avoided.
Many prescription medications and over-the-counter remedies, including dietary supplements and herbs, may alter the effectiveness of warfarin or vitamin K antagonists (detected by the INR) and/or reduce the effectiveness of platelets (not detected by the INR).
Vitamin K may be used to reverse supratherapeutic anticoagulation with warfarin. The dose of vitamin K depends upon the degree of international/normalized ratio (INR) elevation and/or signs and symptoms of bleeding. Vitamin K can lead to warfarin resistance and subsequently to an increased risk of thromboembolism.
Regardless of the anticoagulant used, it is important that patients know they must always inform their physician and other health care providers that they are on anticoagulation therapy, especially if they are undergoing an invasive procedure.
Patients should be encouraged and empowered to play an active role in the self-management of their treatment. Self-management is best initiated and sustained through active involvement of patients and family members with their multidisciplinary health care team. This educational partnership should be encouraged to decrease potential risks and improve understanding of the importance of patient adherence to their treatment regimen.
Patients with mechanical heart valves who are pregnant have complex anticoagulation needs and should be managed by an anticoagulation expert.
Priority Aims:The Antithrombotic Therapy Supplement does not contain priority aims or suggested measures. These components are addressed in the related guidelines.
Additional Background:The ICSI Antithrombotic Therapy Supplement has been developed as a resource for the use of antithrombotic drugs. This is a supplemental document that brings about consistency in recommendations that are common to the scope of related ICSI guidelines. See related ICSI scientific documents: Atrial Fibrillation, Heart Failure in Adults, Diagnosis and Initial Treatment of Ischemic Stroke, Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS), Venous Thromboembolism Diagnosis and Treatment and Venous Thromboembolism Prophylaxis.
Antithrombotic drugs are used to decrease the risk of thrombosis by interfering with the homeostatic clotting mechanism. The major side effect of these drugs is bleeding either from supratherapeutic effect or by accentuating the blood loss of patients with an existing source of bleeding.
There are few absolute contraindications to antithrombotic therapy. The decision to treat a patient with antithrombotic drugs takes into account an individual patient's risk for thrombosis if not treated weighed against the risk of bleeding while on antithrombotic drug therapy.
This supplement and related guidelines should help physicians to make that risk-benefit treatment decision. This supplement is also meant to serve as a tool to use for patients treated with antithrombotic.
A glossary of abbreviations used throughout this guideline is in Appendix F, "Glossary of Abbreviations."
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3. * Atrial Fibrillation (Guideline - 63 pages) open here:
http://www.icsi.org/atrial_fibrillation__guideline_/atrial_fibrillation__guideline__38782.htmlScope and Target Population:This guideline addresses first detected episode and recurrent (paroxysmal, persistent and permanent) atrial fibrillation and atrial flutter in the adult population that present in primary care, emergency room, and the inpatient settings. The scope includes stabilization, assessment, labeling (classification), treatment and patient education.
This document is not intended to replace the comprehensive ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation, which the interested provider is encouraged to review.
Clinical Highlights and Recommendations:There are five key steps in the management of patients with atrial fibrillation or atrial flutter (SALT-E): stabilize, assess, label, treat and educate.
After confirming the diagnosis of atrial fibrillation or atrial flutter with a 12-lead electrocardiogram:
Stabilize Assess for hemodynamic instability (hypotension, myocardial ischemia, uncompensated congestive heart failure, altered mental status or end-organ dysfunction).
Treat hemodynamic instability with emergent direct current cardioversion and obtain an emergent cardiology or internal medicine consult.
Establish adequate rate control.
AssessAssess for potentially reversible causes and for comorbidities of atrial fibrillation/atrial flutter.
Hypertension is one of the most common causes of atrial fibrillation. In addition, hypertension is one of the most common risk factors for thromboembolic complications associated with atrial fibrillation. Treatment for hypertension should be initiated early.
Label Label (classify) patients into one of three categories:
First Detected Episode, Duration Known greater than or equal to 48° or Duration Unknown
Recurrent atrial fibrillation
Paroxysmal
Persistent
Permanent
Recurrent atrial flutter
Treatment options are determined by these three categories.
TreatFirst Detected Episode, Duration Known > 48 hours or Duration Unknown
Patients with stable atrial fibrillation or atrial flutter with duration greater than 48 hours or duration unknown require appropriate anticoagulation (international normalized ratio greater than or equal to 2.0) for three weeks prior to electrical cardioversion or use of antiarrhythmics/chemical cardioversion.
Recurrent atrial fibrillation
Patients with paroxysmal, persistent or permanent atrial fibrillation require assessment for chronic anticoagulation (risk of thromboembolism compared with risk of bleeding) and adequate rate control.
Patients with persistent symptoms despite adequate rate control may require intermittent cardioversion, antiarrhythmic agents and/or electrophysiology consultation.
Recurrent atrial flutterPatients with recurrent atrial flutter should be referred for an electrophysiology consultation.
EducatePatient education is a critical component in the management of all patients with atrial fibrillation/atrial flutter. Patients who have experienced one or more episodes of atrial fibrillation should be taught to periodically monitor their pulse and have a plan for treatment if they detect an irregular pulse.
Priority Aims Increase the percentage of adult patients (age 18 years and older) who are accurately diagnosed with atrial fibrillation/flutter.
Improve the consistency of anticoagulation therapy in adult patients (age 18 years and older) with non-valvular paroxysmal, persistent or permanent atrial fibrillation/flutter.
Improve rate control in adult patients (age 18 years and older) with permanent atrial fibrillation.
Increase the percentage of adult patients (age 18 years and older) with a confirmed diagnosis of atrial fibrillation/atrial flutter who, along with their family, have received education around atrial fibrillation/flutter and anticoagulation therapy.
Reduce the percentage of patient harm associated with the use of anticoagulation therapy.
Increase the percentage of adult patients (age 18 years and older) with a confirmed diagnosis of atrial fibrillation/flutter, receiving dietary monitoring.
Increase the percentage of adult patients (age 18 years and older) with a confirmed diagnosis of atrial fibrillation/flutter who have a medication communication/reconciliation plan throughout the continuum of care.
Additional BackgroundThis guideline follows closely the American College of Cardiology and the American Academy of Family Physician guidelines. Areas of divergence from other clinical practice guidelines are TEE and rhythm vs. rate control. The purpose of this guideline is to provide primary care with a guideline that outlines areas for systems improvement for the diagnosis and treatment of atrial fibrillation in primary care.
A Fib is a common arrhythmia and an important independent risk factor for stroke. The prevalence of A Fib increases from 0.5% for the 50- to 59-year-old age group to 8.8% in the 80- to 89-year-old age group. Symptoms vary from none to severe disabling palpitations, dyspnea and syncope. Patients with A Fib have a mortality rate double that of control subjects. The attributable risk of embolic stroke from A Fib increases from 1.5% per year for the 50- to 59-year-old age group to nearly 30% per year for the 80- to 89-year-old age group, and increases substantially in the presence of other cardiovascular conditions.
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4. * Coronary Artery Disease, Stable (Guideline - 42 pages) open here:
http://www.icsi.org/coronary_artery_disease/coronary_artery_disease__stable_.htmlScope and Target Population:Adults aged 18 and over who meet the stated guideline criteria as identified in Annotation #1, "Patient with Stable Coronary Artery Disease."Adults who have a diagnosis of stable coronary artery disease. The criteria, as noted on the Main algorithm, includes patient presenting with:
previously diagnosed coronary artery disease without angina, or symptom complex that has remained stable for at least 60 days;
no change in frequency, duration, precipitating causes or ease of relief of angina for at least 60 days; and
no evidence of recent myocardial damage.
Clinical Highlights and RecommendationsPrescribe aspirin in patients with stable coronary artery disease if there are no medical contraindications.
Evaluate and treat the modifiable risk factors, which include smoking, sedentary activity level, stress, hyperlipidemia, obesity, hypertension and diabetes.
Patients with chronic stable coronary artery disease should be on statin therapy regardless of their lipid levels unless contraindicated.
Perform prognostic testing in patients whose risk determination remains unclear. This may precede or follow an initial course of pharmacologic therapy.
Refer the patient for cardiovascular consultation when clinical assessment indicates the patient is at high risk for adverse events, the non-invasive imaging study or electrocardiography indicates the patient is at high risk for an adverse event, or medical treatment is ineffective.
For relief of angina, prescribe beta-blockers as first-line medication. If beta-blockers are contraindicated, nitrates are the preferred alternative. Calcium channel blockers may be an alternative medication if the patient is unable to take beta-blockers or nitrates.
Priority AimsIncrease the percentage of appropriate patients with an appropriate diagnosis of stable coronary artery disease (SCAD), who are prescribed aspirin and antianginal medications.
Improve education/understanding around the management of stable coronary artery disease.
Increase the percentage of patients with stable coronary artery disease who receive an intervention for modifiable risk factors.
Improve the assessment of patients with a diagnosis of stable coronary artery disease who present with angina symptoms.
Increase the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBS) in patients with coronary artery disease, including those patients with a diagnosis of diabetes, chronic kidney disease, and hypertension.
Increase the percentage of patients with a diagnosis of stable coronary artery disease who receive education around nutritional supplement therapy.
Increase prognostic testing for patients whose risk determination remains unclear.
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5. * Heart Failure in Adults (Guideline - 120 pages) open here:
http://www.icsi.org/heart_failure_2/heart_failure_in_adults_.htmlScope and Target Population:The management of adult patients age 18 and older with suspected heart failure and heart failure requiring hospitalization.
Clinical Highlights and Recommendations:Evaluate patients presenting with heart failure for exacerbating and underlying causes, including coronary artery disease, hypertension, valvular disease and other cardiac and non-cardiac causes.
Studies show that the distinction between systolic dysfunction and preserved systolic function is important, because the choice of therapy may be quite different and some therapies for systolic dysfunction may be detrimental if used to treat preserved systolic function.
After evaluation, diagnosis and initiation of pharmacologic and non-pharmacologic management of heart failure, follow-up in the ambulatory setting should focus on optimizing pharmacologic and non-pharmacologic therapy and preventing heart failure exacerbations. Patient education is central in this effort.
Daily weights are critical for managing heart failure and early detection of increases in fluid retention. Patients should call their provider about a two-pound or greater weight gain overnight or a five-pound or greater weight gain in a week.
Unless specific contraindications exist, treat all patients, including Class IV patients, with beta-blockers, starting with a low dose and titrating upward. Do not unnecessarily reduce or discontinue beta-blockers in severe or decompensated heart failure. After fluid overload and hypotension are corrected and when only one drug can be initiated, beta-blockers are preferred.
Treat all patients with left ventricular systolic dysfunction with ACE inhibitors (or ARBs if intolerant) unless specific contraindications exist, such as intolerance or adverse reactions to ACE inhibitors, serum potassium greater than 5.5 mEq/L, symptomatic hypotension, severe renal artery stenosis or pregnancy. Gradually titrate dose up over a two- to three-month period.
Consider treatment with aldosterone antagonists for Class III and IV heart failure patients with appropriate follow-up.
Consider early specialty referral for patients with ischemia or those who are refractory despite optimal medical therapy.
Brain natriuretic peptide (BNP) and proBNP is useful in the diagnosis and prognosis of heart failure in patients with dyspnea of unknown etiology.
Priority Aims:Decrease the readmission rate within 30 days of discharge following hospitalization for heart failure.
Optimize the pharmacologic treatment of adult patients with heart failure.
Improve the use of diagnostic testing in order to identify and then appropriately treat adult patients with heart failure.
Improve care of adult heart failure patients by assuring comprehensive patient education and follow-up care.
Additional Background:Facts about congestive heart failure:
3,000,000 patients in the United States have HF.
15,000,000 patients worldwide have HF.
Approximately 400,000 are diagnosed with HF each year in the United States.
It is the most common discharge diagnosis in patients age 65 and older.
Approximately 200,000 HF-related deaths occur each year in the United States.
Population demographics suggest these figures will continue to increase.
The guideline follows closely the Agency for Health Care Policy and Research (AHCPR) Heart Failure guideline. The only significant deviation is we recommend assessment of left/ventricular (LV) function earlier.
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6
. * Hypertension Diagnosis and Treatment (Guideline - 60 pages) open here:
http://www.icsi.org/hypertension_4/hypertension_diagnosis_and_treatment_4.htmlScope and Target Population:Adults age 18 or older.
Clinical Highlights and Recommendations:Confirmation of hypertension is based on the initial visit, plus two follow-up visits with at least two blood pressure measures at each visit.
Standardized blood pressure measurement techniques (including out-of-office or home blood pressure measurements) should be employed when confirming an initially elevated blood pressure and for all subsequent measures during follow-up and treatment for hypertension.
A thiazide-type diuretic should be considered as initial therapy in most patients with uncomplicated hypertension.
Physician reluctance to initiate and intensify treatment is a major obstacle to achieving treatment goals.
Systolic blood pressure level should be the major factor for the detection, evaluation and treatment of hypertension, especially in adults 50 years and older.
Fewer than 50% of patients with hypertension will be controlled with a single drug.
Priority AimsIncrease the percentage of adult patients in blood pressure control.
Improve the assessment of adult patients with hypertension.
Increase the percentage of adult patients with hypertension who receive patient education, with a focus on the use of non-pharmacological treatments.
Increase the percentage of adult patients not in blood pressure control who have a care plan.
Increase the percentage of adult patients not at blood pressure goal who have a change in subsequent therapy.
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7. * Lipid Management in Adults (Guideline - 73 pages) open here:
http://www.icsi.org/lipid_management_3/lipid_management_in_adults_4.htmlScope and Target Population:This guideline describes the treatment of adults age 20 and older who are dyslipidemic.
Clinical Highlights and Recommendations:Initiate a statin with patients who have a history of CHD or CHD risk equivalent.
Establish lipid goals based on risk level.
Instruct patients on healthy lifestyle and adjunctive measures.
Patient adherence with recommended therapy should be reinforced during scheduled follow-up.
LDL goal less than 70 can be considered for patients with established CAD, non-cardiac atherosclerosis or coronary artery disease equivalent.
Priority Aims:
Increase the percentage of patients with CHD or whose 10-year risk is greater than 20% who are on a statin.
Improve the percentage of patients with or without CHD who meet their lipid treatment goals.
Increase adherence with adjunctive treatment of patients with CHD or CHD risk equivalent through education.
Improve the percentage of patients on lipid-lowering medication who receive regular follow-up care for lipid disorder.
Increase the percent of patients on lipid-lowering therapy who remain on therapy.
Additional Background:The guideline is a natural follow-up to the ICSI Preventive Services for Adults Guideline. Management of lipid disorder in adults is an area of practice variability among providers. The condition is relatively common in the adult population and treatment costs can be significant. The guideline incorporates recommendations from the National Cholesterol Education Program (NCEP-ATP III) and research studies which include: the Framingham Study, WOSCOPS, TexCAPS, 4S, Helsinki Heart Study, HITS Trial, The LIPID Study, and HERS.
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. * Stroke, Ischemic, Diagnosis and Initial Treatment of (Guideline - 64 pages) open here:
http://www.icsi.org/stroke/diagnosis_and_initial_treatment_of_ischemic_stroke___pdf_.htmlScope and Target Population:The scope of the following guideline is the 48 hours beginning when a patient age 18 years or older presents to a provider with symptoms of ischemic stroke or transient ischemic attack. For most stroke patients who are hospitalized, the guideline's temporal scope will expire before discharge. The guideline work group on Diagnosis and Initial Treatment of Ischemic Stroke recognizes that two time frames are critically important in the overall outcome, and fall outside the defined scope. They are prehospital care, and continuing care of stroke patients after 48 hours, which includes the development of a long term secondary prevention strategy. While the group has not itself performed a systematic review of the primary evidence on these matters, we recommend the following guidelines from the American Heart Association/American Stroke Association.
Clinical Highlights and Recommendations:Patients presenting with signs and symptoms of TIA should be evaluated for risk of immediate future events using the ABCD score.
Patients who present in time to be candidates for treatment with intravenous tissue plasminogen activator (tPA) should be evaluated by a physician within 10 minutes, undergo a CT scan within 25 minutes of arrival in the ED, and have CT interpreted within 20 minutes of test completion.
tPA, if given, should be administered within three hours (4.5 hours in selected patients; see Annotation #18, "Consider IV Tissue Plasminogen Activator [tPA]/See Stroke Code Algorithm") of stroke onset and less than 60 minutes of arrival at the ED.
Patients presenting with stroke onset who are not candidates for intravenous tPA should promptly be given aspirin, after exclusion of hemorrhage on CT scan.
Education regarding early stroke symptoms, risk factors, diagnostic procedures, and treatment options should be offered to the patient and family. This should be documented in the patient chart.
Medical management for prevention of complications within the initial 24-48 hours of diagnosis and initial treatment of ischemic stroke include:
- continue appropriate blood pressure management;
- continue to treat hyperthermia;
- continue to treat hypo- or hyperglycemia;
- continue IV fluids;
- initiate deep vein thrombosis prophylaxis;
- perform swallow evaluation;
- initiate early rehabilitation; and
- perform nutritional status assessment.
Priority Aims:1. Increase the percentage of patients presenting within three hours of stroke onset who are evaluated within 10 minutes of arriving in the ED.
2. Increase the percentage of patients presenting with TIA symptoms within 24 hours at high risk for stroke who are admitted to the hospital.
3. Increase the percentage of patients receiving appropriate thrombolytic and antithrombotic therapy for ischemic stroke (use of tPA and aspirin).
4. Increase the percentage of non-tPA recipients who have hypertension appropriately managed in the first 48 hours of hospitalization or until neurologically stable.
5. Increase the percentage of patients who receive appropriate medical management for prevention of complications within the initial 24-48 hours of diagnosis:
.Continue to treat hypoglycemia and hyperglycemia
.Continue to treat hyperthermia
.Continue IV fluids
.Continue to treat hypoxia
.Initiate deep vein thrombosis prophylaxis
.Perform swallow
.Initiate early rehabilitation (early mobilization)
.Perform nutritional status assessment
6. Improve patient and family education of patients with ischemic stroke in both the ED and the admitting hospital unit.
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9. * Venous Thromboembolism Diagnosis and Treatment (Guideline 80 pages) open here:
http://www.icsi.org/venous_thromboembolism/venous_thromboembolism_4.htmlScope and Target Population:Adult patients age 18 and over with venous thromboembolism (VTE).
Clinicians Highlights and Recommendations:A clinical pretest probability assessment should be completed in patients with suspected venous thromboembolism.
D-dimer can be used as a negative predictor to eliminate need for further testing.
Confirm diagnosis of DVT with imaging study, preferably duplex ultrasound (with compression).
In patients with a high clinical pretest probability for PE, begin anticoagulation without delay.
Computed tomographic angiography combined with clinical pretest probability scoring and D-dimer testing has the predictive value to safely diagnose or rule out pulmonary embolism in patients. Additional diagnostic testing is necessary only when clinical symptoms persist or progress.
Achieve rapid effective anticoagulation with LMWH/fondaparinux.
In patients with acute VTE, heparin (UFH or LMWH/fondaparinux) should be given for at least four days and until the INR is 2.0 for two consecutive days.
Arrange for home therapy in appropriate patients.
Graded compression stockings help prevent post-phlebotic syndrome. All patients should be assessed for the need for compression graded stockings (not Teds).
Patient to be treated three to six months for acute thrombosis followed by
re-evaluation of ongoing risks to determine the need for ongoing anticoagulation therapy to prevent recurrent events.
Priority Aims:Prevent progression or recurrence of thromboembolic disease.
Reduce the risk of complications from anticoagulation therapy.
Improve the safety of using medications by reducing the likelihood of patient harm associated with the use of anticoagulation therapy.
Improve accurate diagnosis and treatment of venous thromboembolism (VTE).
Increase the percentage of patients who are evaluated upon change in level of care, and/or upon discharge.
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10. * Venous Thromboembolism Prophylaxis (Guideline - 30 pages) open here:
http://www.icsi.org/venous_thromboembolism_prophylaxis__2__guideline_/venous_thromboembolism_prophylaxis__guideline__47057.html Scope and Target Population:This guideline addresses risk assessment for venous thromboembolism, risk assessment for bleeding, and mechanical and pharmacologic therapies to reduce the occurrence of venous thromboembolism in adult hospitalized patients.
Clinical Highlights and Recommendations:All patients should be evaluated for venous thromboembolism risk upon hospital admission, change in level of care, change in providers, and prior to discharge.
All patients should receive proper education regarding venous thromboembolism risk, signs and symptoms of venous thromboembolism, and mechanical prophylaxis methods available.
Early and frequent ambulation should be encouraged when possible in all patient groups.
All medical and surgical/trauma patients who have a high or very high risk for venous thromboembolism should receive anticoagulation prophylaxis unless contraindicated.
Aspirin alone is not recommended for routine venous thromboembolism prophylaxis following hip/knee arthroplasty but may be considered in combination with mechanical prophylaxis methods in patients without additional risk factors. Further study is needed.
For all patients receiving spinal or epidural anesthesia, precautions should be taken when using anticoagulant prophylaxis to reduce the risk of epidural perispinal hematoma.
Risk of venous thromboembolism development continues beyond hospitalization, and the need for postdischarge anticoagulation should be assessed.
Priority Aims:Increase the percentage of hospitalized adult patients (18 years and older) who are appropriately assessed for venous thromboembolism risk within 24 hours of admission.
Increase the percentage of adult patients (18 years and older) who are evaluated for venous prophylaxis upon change in level of care, change in providers, and/or upon discharge.
Increase the percentage of hospitalized adult patients (18 years and older) who are at risk for venous thromboembolism who have received education within 24 hours of admission for venous thromboembolism that includes venous thromboembolism risk, signs and symptoms, and treatment/prophylaxis methods.
Improve the safety of using medications by reducing the likelihood of patient harm associated with the use of anticoagulation therapy.
Increase the percentage of hospitalized adult patients who begin early and frequent ambulation.
Increase the percentage of hospitalized adult patients (18 years and older) receiving appropriate pharmacological and/or mechanical prophylaxis treatment within 24 hours of admission.
Reduce the risk of complications from pharmacologic prophylaxis.
Increase the percentage of surgery patients who receive appropriate venous thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery.
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