Sudden death is the first symptom for 25% of all patients who develop a pulmonary embolism. For surgical patients, almost half of all venous thromboembolism (VTE) events don’t become evident until after discharge within days or up to several weeks after surgery.

Did you know you can drastically reduce your patients’ risk of developing a deadly postoperative blood clot with correct pre-operative risk assessment and patient education?

“Vigilance and prevention are keys to increasing patient and family awareness about the very real and often underdiscussed dangers of postoperative VTE,” stresses Emily Jones, MSN, RN, CNOR, NPD-BC, AORN perioperative practice specialist. She’s lead author of AORN’s recent update to the Guideline for Prevention of Venous Thromboembolism, which was released last month.

Save a Life

Jones says, “nurses hold the keys to assessing VTE risk and educating patients and families to be proactive about preventing this post-operative danger.”

Do your part by taking these 3 VTE prevention actions before surgery:

1. Use a Standardized and Validated VTE Risk Assessment Tool

“Using a validated assessment tool that is standard throughout your organization can help ensure that all clinicians are on the same page when it comes to VTE risk assessment,” Jones recommends.

She suggests using the Caprini VTE risk assessment tool for surgical patients. The clinician works with the patient to identify which VTE risk factors are present and then adds up their score. The VTE risk score is used along with the risk of bleeding to formulate the optimal VTE prevention plan for the individual patient. “It’s important to involve the patient—researchers found that when the patient and a family member are involved in the VTE risk assessment, significant VTE risk factors such as a family or personal history of blood clots were more likely to be identified.”

Example: An otherwise healthy 42-year-old with a family history of blood clots having minor surgery yields a Caprini score of 5, which would likely categorize the patient as ‘high risk’ for VTE. Accurate VTE assessment and collaboration with the surgical team can help ensure this patient receives the appropriate VTE prophylaxis and could impact whether or not the patient develops a blood clot.

Tip for new nurses: Speak up if your facility does not use a standardized and validated VTE risk assessment. Review the open access Caprini Risk Score and share it with your team.

2. Begin Patient Education About VTE Prevention Before Surgery

“Starting VTE patient and family education before surgery can really help patients understand what they can do to help prevent blood clots,” Jones says.

Example, nurses can talk to their patients about the importance of wearing the graduated compression stockings or pneumatic compression devices for the prescribed amount of time, taking any prescribed anticoagulant medications according to the instructions, and getting up to walk around as soon as it is safe after surgery.

Tip for new nurses: Get comfortable with the facts on VTE and share education resources with your patients, such as these:

• Learn About Venous Thromboembolism
• Hospitalization and Blood Clots Infographic
• Stop The Clot, Spread The Word™ - Blood Clot Awareness
• Risk Factors for Venous Thromboembolism

3. Strategize Post-Op Ambulation Before the Procedure

“Early and frequent ambulation is so important for all postoperative patients to help decrease venous stasis after surgery, which reduces the risk for a blood clot to form,” Jones stresses. That’s why all patients should receive preoperative education to plan for early and frequent ambulation after surgery.

Patients can also learn about performing foot and ankle exercises, as long as it’s clear that these exercises alone are not a safe alternative to ambulation for VTE risk reduction, she adds, noting that “walking is best when possible.” “We want to be sure clinicians help patients understand all of the strategies to help prevent blood clots from developing.”

Tip for new nurses: Prepare patients and family members or other caregivers with the expectations about getting up to walk around as soon as possible after surgery and explain how this reduces VTE risk.

“This preoperative education with the patient and family can also be an opportunity for the nurse to help clear up misconceptions about postoperative ambulation because some people may think that a patient should only stay in bed to rest after surgery,” Jones suggests.

She does caution that every patient situation is different, that’s why this preop conversation is so important. “The nurse and clinical team will assess the patient’s fall risk and help prevent falls by identifying and addressing barriers to early ambulation.”

Review all of the latest evidence-based practices for VTE prevention in the Guideline for Prevention of Venous Thromboembolism at aornguidelines.org.