Caring for M was significantly helped by guidance from the recently released OB VTE Safety Recommendations, which offer a defined clinical process that covers the entire continuum of care. These recommendations provide a much-needed road map to navigate the care of pregnant patients to help prevent VTE. Previously, patients at highest risk—those with a history of VTE or PE—were a "known" in terms of how to provide care, but all of the other risk factors are now being brought to the attention of physicians and nurses, which enables clinicians to provide the best possible care to patients.
Implementation of the OB VTE Safety Recommendations involves a four-step process that should be followed from the moment an OB patient is admitted until the patient is discharged home and her follow-up care is completed. The four-step process was designed to remind clinicians of the safety recommendations and, again, should be considered throughout the patient’s entire continuum of care.
The relevant advantages of this four-step process include:
- Ease of implementation and adoption across the OB specialty.
- Identification of a consistent baseline and reassessment of patients’ individual risk factors.
- Early identification of the patient’s actual level of risk.
- Identification of which VTE prevention prophylactic measures are most appropriate and when they should be implemented.
- Detailed discharge instructions with documented patient understanding. These are developed early in the course of care and provided to the patient, who is required to “read back” the instructions to determine the patient’s level of understanding.
- Patient engagement and education. This gives the patient the tools and confidence to self-advocate throughout the care cycle.
- Engagement of family members and significant others in the discharge planning process. The patient’s immediate support system can be assigned roles to help the patient empower herself and to encourage her to stay on course.
It is important to remember that the commitment to prevent VTE does not end when the patient is discharged. Appropriate patient education will help the patient understand the importance of complying with discharge medications, use of sequential compression devices at home, and frequent ambulation, and returning for all follow-up appointments.
To achieve the most optimal clinical outcomes, pre-planning is key when there are multiple challenging individual patient characteristics, as was the case with patient M. Priorities and pre-identification of what the clinician actually needs to treat a patient at high-risk for complications should be discussed and determined in advance within the provider team. This type of anticipatory troubleshooting is a necessary task but not always easily accomplished. It requires a knowledgeable team and the best available tools, so that all possible clinical scenarios that may be encountered can be considered.