Preventing venous thromboembolism
Venous thromboembolism (VTE) comprises both deep vein thrombosis (DVT) and pulmonary embolism (PE) and has been associated with increased postoperative complications in the non-hospital setting. Although VTE is most often associated with hospital-acquired VTE and higher risk major surgeries, it is recommended that all surgical patients be assessed for VTE risk and, if deemed appropriate, that thromboprophylaxis (anticoagulant and/or mechanical) be given. As preoperative screening for VTE is an important step in identifying patients at risk, non-hospital medical and surgical facilities must ensure that patients’ preoperative assessment and health history includes screening protocols for VTE.
In developing VTE screening protocols, it is recommended that facilities follow the BC Patient Safety & Quality Council (BCPSQC) VTE prevention Getting Started Kit (May 2012), which is based on the American College of Chest Physicians (ACCP) Guidelines, considered the most comprehensive and most utilized evidence-based guidelines on the prevention of VTE. Facilities can find VTE resources and tools developed by other organizations under Resources on the BCPSQC’s website.
Minor procedures under local anesthesia only
Medical directors are reminded that a pre-admission assessment including but not limited to: physical exam, medical history, ASA classification, body mass index (BMI) and preoperative testing based upon the patient’s clinical conditions and the planned procedure, must be performed on all patients, including patients having minor procedures under local anesthesia only. In addition, minor procedure rooms must be appropriately staffed and procedure documentation must provide an accurate account of the patient’s status, the actions of the perioperative team, and the patient’s outcome.
Facilities are reminded that all incidents must be reported to the College using the Reportable Incident Form. Facilities must notify the NHMSFP within one working day after the discovery of an incident followed up with submission of the Reportable Incident Form and supporting documentation within five business days. Failure to report may result in an investigation or the registrant’s non-compliance and may be considered an act of professional misconduct.
PharmaNet—a vital component of pre-admission evaluation and patient selection
The Non-Hospital Medical and Surgical Facilities Program Committee recommends that a PharmaNet record review be included in the pre-admission evaluation and patient selection procedures of non-hospital facilities. PharmaNet, a province-wide network developed to promote better patient care and improve prescription safety, can provide an accurate and complete patient medication profile which is an essential part in providing safe and appropriate patient care. PharmaNet is best utilized as a component of the medication reconciliation process, which is part of the patient’s pre-operative admission history. PharmaNet is especially vital if language barriers exist which may hamper communication between the health-care provider and the patient, or if patients are currently prescribed controlled drugs and substances (e.g. hydromorphone).