Question: DVT Prophylaxis and Ambulation

This question has follow-up question(s): Reason for No VTE Prophylaxis

If a stroke patient is ambulating do they need another form of DVT prophylaxis?

Answer:

Yes. The data element *Patient Ambulatory By End of Hospital Day 2* has been removed from the algorithm. Ambulatory stroke patients are in the measure population. Ambulation is not considered prophylaxis; therefore, if a form of prophylaxis is not administered or a reason for not administereing VTE prophylaxis documented, the case will fail the measure.

All stroke patients should receive prophylaxis on the day of or day after hospital admission OR a reason for not administering prophylaxis (Reason for No VTE Prophylaxis Hospital Admission) needs to be documented in the medical record, (e.g., “pt. up ad lib – no prophylaxis”, “heme + NG drainage – hold SQ heparin”) in order to be included in the numerator population and pass the measure. Prophylaxis can be pharmcologic, (i.e., unfractionated SQ heparin, LMWH, warfarin, Factor Xa Inhibitor) or mechanical (i.e., IPC/SCDs, venous foot pump).

GCS as the only form of prophylaxis is not sufficient for the stroke patient and will fail the measure. When GCS alone is the only form of prophylaxis administered for the stroke patient, a documented reason for not administering another form of prophylaxis is needed to pass the measure.

To view the full data element definitions for VTE Prophylaxis and Reason for No VTE Prophylaxis-Hospital Admission, open the Alphabetical Data Element Dictionary PDF using the link below.

http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Current+NHQM+Manual.htm