nurse-driven sequential compression device (SCD) protocol.
Our surgeons fully supported the use of pre-op SCD application, but
delays in obtaining their orders didn't always lead to timely applica-
tion. The literature shows that SCDs should be on in pre-op, but in too
many cases we weren't getting SCDs on until the patient was in the
operating room. This was the first change we implemented, and it
paid dividends. It eliminated having to wait for surgeons' orders on
the day of the procedure.
With administrative support, we added additional SCD pumps in our
perioperative space. This allows for SCDs to be applied and running
in pre-op. The OR nurse will then hook them up in the OR to run
throughout the course of the procedure. When the patient goes to
recovery, the SCDs can be hooked back up again.
3. Perform pre-op assessments
Our diverse team reviewed the literature, and we reached out to coun-
terparts to see what VTE risk assessment tools they were using. We
determined the Caprini Score tool (osmag.net/d3WoSB) was the
most widely used and adopted. Caprini delivers a VTE risk score
based on a wide variety of factors, including (but not limited to) age,
gender, length of surgery, medical events that might have occurred
with the patient over the previous month, any indications of venous
disease or clotting disorders, and other present and historical health
indicators and comorbidities.
A process was implemented with a pilot group of surgeons to com-
plete the VTE risk assessment and submit it with the scheduling work-
sheet. This provided the surgeon with the patient's VTE risk score to
determine ordering pre-op and post-op chemoprophylaxis. Following
the success of the pilot group, the VTE risk assessment was shared with
all surgeons to complete for all surgical cases. The VTE committee
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