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|\n| Date(s) of Surgery: |  |  |  |  | Principle Procedure: |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n| Principle Diagnosis: |  |  |  |  |  |  |  |  |  |  |\n| Age: |  |  |  | Gender: □Male □Female |  |  | BMI: |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n| Findings: |  |  |  |  |  |  |  |  |  |  |\n| Evidence for DVT/PE: |  |  |  |  |  |  |  |  |  |  |\n| VTE Diagnosed on: □HD\\#  □ POD\\#   |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n| VTE Risk Assessment Completed? □ Yes □ No |  |  |  | VTE Risk Score:   |  |  | VTE Risk Assessment Accurate? □ Yes □ No |  |  |  |\n|  |  |  |  |  |  |  |  |  | □ Correct Risk Score | □Correct Risk Category |\n| For SURGICAL patients only: □NA |  |  |  |  |  |  |  |  |  |  |\n|  | Anesthesia: □General □ Regional □ Epidural □Local |  |  |  |  |  |  |  |  |  |\n|  | Operative duration:   |  |  |  |  |  |  |  |  |  |\n|  | PREOPerative heparin: □SQH ordered □SQH Administered □None |  |  |  |  |  |  |  |  |  |\n|  | INTRAOPerative prophylaxis given: □SCDs □IV Heparin □None |  |  |  |  |  |  |  |  |  |\n|  | POSTOPerative PACU: □SCDs □SQH □None |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n| For ALL patients: |  |  |  |  |  |  |  |  |  |  |\n|  | Inpatient VTE prophylaxis ordered: □ NA □ Date chemoprophylaxis ordered  |  |  |  |  |  |  |  |  |  |\n|  |  | □ Heparin SQ □ Daily □BID □TID |  |  |  | □ Fondaparinux |  |  |  |  |\n|  |  | □ Enoxaparin □ 40mg daily □30mg BID |  |  |  | □Sequential Compression Devices (SCDs) □Date ordered:  |  |  |  |  |\n|  |  | □Warfarin □ LWMH or IV UFH until INR therapeutic |  |  |  | □other:   |  |  |  |  |\n|  | Inpatient VTE prophylaxis orders match VTE risk score? □ Yes □ No\u003Cbr>(Based on UM-Carelink VTE Risk Assessment Tool or Service Specific Guidelines Preapproved by the VTE Committee) |  |  |  |  |  |  |  |  |  |\n|  | Timely prescription for VTE prophylaxis 1? □ Yes □ No |  |  |  |  |  |  |  |  |  |\n|  | Prophylaxis administered appropriately2 (i.e. no delays, missed doses, patient refusals, or suspended orders; *If NO , provide details in Comments Box)?\u003Cbr>□ Yes □ No* |  |  |  |  |  |  |  |  |  |\n| Event Determination: □Not preventable3 (prophylaxis failure) □ Potentially Preventable4 (process failure) |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n| Comments: |  |  |  |  | Quality Improvement Opportunities:\u003Cbr>□VTE risk assessment inaccurate\u003Cbr>□Suboptimal prophylaxis orders based on patient risk\u003Cbr>□ Delay in initiating prophylaxis\u003Cbr>□Missed administration doses of prophylaxis / prophylaxis orders suspended\u003Cbr>□Contraindication documented inaccurately (e.g. thrombocytopenia)\u003Cbr>□No alternative VTE chemoprophylaxis ordered when HIT known/suspected (e.g. fondaparinux, argatroban)\u003Cbr>□No mechanical (SCDs) ordered for true contraindications to chemoprophylaxis\u003Cbr>□Lack of LMWH bridging until INR therapeutic\u003Cbr>□Lack of discharge/extended prophylaxis\u003Cbr>□Other:   |  |  |  |  |  |\n\nVTE Case Review Template  \nData Definitions:  \n1 Timely Prescription for VTE Prophylaxis – Orders for VTE prophylaxis written within 1 hour of inpatient admission  \n2 Prophylaxis administered appropriately –  \n1. No delay > 1 hour in administration from the time VTE prophylaxis orders written  \n2. Excluding admission and discharge day, zero missed doses of administered VTE prophylaxis  \na. Includes patient refusals  \nb. Includes suspended orders  \n3 Not Preventable – Prophylaxis failure whereby the standard of care was met with ALL ofthe following:  \n1. Intraoperative SCDs for most surgical patients  \n2. Accurate risk assessment (proper risk category: low, moderate, high, highest) if not prescribed high risk chemoprophylaxis  \n3. Proper inpatient prophylaxis orders based on risk assessment & service specific prophylaxis guidelines preapproved by the VTE Committee  \n4. Timely prescriptio","cbCaigQuelwRwQh2","https://ap.wps.com/l/cbCaigQuelwRwQh2","pdf",50768,"English","# Patient & VTE Data\n## Basic Information and Diagnosis\n## Findings and Evidence for DVT/PE\n## VTE Risk Assessment","[{\"question\":\"模板需要填写哪些患者与VTE基础信息？\",\"answer\":\"包括患者的CPI编号、入院日期、出院日期、手术日期范围、主要手术操作与主要诊断，以及年龄、性别、BMI等信息，并记录DVT/PE相关发现与证据。\"},{\"question\":\"VTE风险评估应如何在模板中核对？\",\"answer\":\"需勾选VTE风险评估是否完成、风险评分以及风险评估准确性；若勾选不准确，还需在模板中注明“正确风险评分/正确风险类别”。\"},{\"question\":\"事件如何在模板中区分为Not preventable还是Potentially preventable？\",\"answer\":\"Not preventable要求在标准流程均满足（包括手术患者的SCD使用、准确风险评估与基于风险的预防医嘱、医嘱开立及时且给药无漏失、必要禁忌症处理与HIT情形下的替代预防）。Potentially preventable则表示至少存在一个可改进的流程失败。\"}]","VTE Case Review Template - Committee Case Review | PDF"]