National Consensus Standards for Prevention and Care of Venous Thromboembolism (VTE) - Last Updated  10/2008

Background

The ‘National Consensus Standards for the Prevention and Care of Deep Vein Thrombosis (DVT)’ project between The Joint Commission and the National Quality Forum (NQF) formally began in January 2005.  The Call for Nominations for the Steering Committee (SC) and Technical Advisory Panel (TAP), Measures, Preferred Practices and Model Organizational Policies was issued January 7, 2005.  Members for both SC and TAP were selected in March 2005.  After the initial SC meeting in June 2005, it was decided that the project should encompass DVT and pulmonary embolism (PE); resulting in a name revision to the ‘National Consensus Standards for the Prevention and Care of Venous Thromboembolism (VTE)’ project.  The Joint Commission’s role as the sub-contractor was to identify and develop a set of standardized, inpatient measures that will evaluate healthcare practices for this condition.

At the initial TAP meeting in July 2005, four domains of VTE were identified: risk assessment, prevention, diagnosis and treatment.  17 key characteristics of preferred practices were developed based on the four domains.  The measure submissions were reviewed, but did not encompass all of the domains, so a decision was made to post a more targeted call for measures; that call occurred in August 2005. 

Through collaboration, along with the advice and guidance of the SC and TAP, an initial set of 19 VTE Candidate Performance Measures addressing key aspects of VTE were identified in December 2005 from over 50 submissions.  Following public comment in January 2006, the TAP recommended that 10 of the 19 measures move forward with modifications for testing using a multi-phased testing approach.  During the summer of 2006, an alpha test was conducted in a limited number of organizations with the objectives of assessing face validity and data collection issues.  The results from alpha testing were reviewed by the TAP, and the following eight measures were recommended to move forward, with modifications, to pilot testing:

From January 2007 – June 2007, 55 volunteer hospitals that were randomly selected based on a range of geographic, demographic, and other factors representative of acute healthcare services in the U.S., pilot tested the measures.

In October 2007, the TAP reviewed the pilot test results and recommended that the eight pilot measures be modified to seven measures (two treatment measures combined), and move forward to the NQF VTE SC November 2007 meeting for approval and recommendation to continue in the NQF Consensus Development Process (CDP).  All seven measures were recommended by the SC, and are listed below.

November 2007

Draft VTE Candidate Measures

Prevention

• VTE Prophylaxis
• ICU VTE Prophylaxis

Treatment

• Inferior Vena Cava Filter Indication (for QI use only)
• VTE Patients with Anticoagulation Overlap Therapy
• VTE Patients Receiving UFH with Dosages / Platelet Count Monitoring by Protocol or Nomogram 
• VTE Discharge Instructions

Outcome

• Incidence of Potentially-Preventable VTE

October 2008

The following six Venous Thromboembolism (VTE) measures were endorsed by NQF in May, 2008:

• VTE Prophylaxis
• ICU VTE Prophylaxis
• VTE Patients with Anticoagulation Overlap Therapy
• VTE Patients Receiving UFH with Dosages / Platelet Count Monitoring by Protocol or Nomogram
• VTE Discharge Instructions
• Incidence of Potentially-Preventable VTE

It is anticipated that the VTE measures will be available for data collection and reporting for discharges beginning in late 2009 and complete measure specifications will be available in early 2009.  Questions regarding the VTE measure set can be directed to Harriet Gammon, MSN, RN, CPHQ at hgammon@jointcommission.org. 

Reference Materials:

• View the August 6, 2004 News Release on the Joint Commission, National Quality Forum plan to work on a Deep Vein Thrombosis prevention and care project.