VTE Prophylaxis Assessment Checklist
Assess all hospitalized patients for venous thromboembolism risk and implement appropriate prophylaxis measures per Joint Commission requirements.
- Industry: Healthcare
- Frequency: Admission and ongoing
- Estimated Time: 5-10 minutes
- Role: Physician/Nurse
- Total Items: 29
- Compliance: Joint Commission VTE Core Measures, ACCP Guidelines, CMS VTE Prevention
VTE Risk Factors
Identify patient risk factors
- Prior VTE history?
- Active cancer or chemotherapy?
- Major surgery within 3 months?
- Reduced mobility/bed rest?
- Known hypercoagulable state?
- Age over 60?
- Obesity (BMI > 30)?
- Pregnancy or postpartum?
- Central venous catheter?
Bleeding Risk/Contraindications
Assess bleeding risk
- Active bleeding?
- Known bleeding disorder?
- Recent major hemorrhage?
- Severe thrombocytopenia (<50K)?
- Epidural catheter in place?
- Recent intracranial hemorrhage?
Prophylaxis Selection
Choose appropriate prophylaxis
- Pharmacologic prophylaxis ordered?
- Appropriate drug selected (LMWH, UFH, fondaparinux)?
- Mechanical prophylaxis ordered (SCDs, IPC)?
- If no prophylaxis, contraindication documented?
Implementation Verification
Verify prophylaxis given
- VTE prophylaxis medication administered?
- Mechanical devices applied and functioning?
- Early ambulation encouraged?
Patient Education
VTE education provided
- Patient educated about VTE risks?
- Signs/symptoms of DVT/PE discussed?
- Discharge VTE prevention instructions given?
Infection Prevention & Control
Infection control per CDC/Joint Commission
- Hand hygiene compliance observed?
- Isolation precautions followed correctly?
- Sharps containers not overfilled?
- Appropriate PPE available and used?
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Why Use This VTE Prophylaxis Assessment Checklist?
This vte prophylaxis assessment checklist helps healthcare teams maintain compliance and operational excellence. Designed for physician/nurse professionals, this checklist covers 29 critical inspection points across 6 sections. Recommended frequency: admission and ongoing.
Ensures compliance with Joint Commission VTE Core Measures, ACCP Guidelines, CMS VTE Prevention. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the VTE Prophylaxis Assessment Checklist cover?
This checklist covers 29 inspection items across 6 sections: VTE Risk Factors, Bleeding Risk/Contraindications, Prophylaxis Selection, Implementation Verification, Patient Education, Infection Prevention & Control. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed admission and ongoing. Each completion takes approximately 5-10 minutes.
Who should use this VTE Prophylaxis Assessment Checklist?
This checklist is designed for Physician/Nurse professionals in the healthcare industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.