Questionnaire - word

Attachment 4
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CDC)
Exp. Date xx/xx/20xx

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Evaluation of Venous Thromboembolism Prevention Practices in U.S. Hospitals
NOTE
This questionnaire is designed for use in electronic online format. While this hard copy version shows the
skip logic that is built into the online version, it does not present the display logic that is inherent in the
online questionnaire. Because of the display logic, in the online version a respondent will only see
questions relevant to them depending on answers provided in previous questions. The display feature
considerably reduces redundancies in the online survey however it cannot be adequately presented in
this hard copy.
What is the primary role (or title) of the person completing this questionnaire?
________________________________________________________________________________
Thank you for agreeing to participate in the evaluation of venous thromboembolism (VTE) prevention
practices in U.S. hospitals. It is important to note that the questionnaire is focused on providing an
accurate snapshot of current VTE activities in U.S. hospitals. There are no right, or wrong answers and
the questions are not intended to suggest hospitals should be doing certain activities.
Instructions for completing the online questionnaire:
• Use the back and forward arrows at the bottom of each page to navigate the pages
on the questionnaire.
• Italicized words are instructional.
• For words that are underlined, hover over the word and a definition is provided. Please note that
you will not be able to see definitions of underlined words if you are taking this survey on your
mobile device.
• There are no required questions; you are free to skip any question that you choose.
• Your answers are automatically saved, and you can exit and re-enter to continue responding to
the questionnaire as long as you have not clicked the 'Submit' button on the last page.
• The last page of the questionnaire provides space for any additional comments.
• When you reach the end of the questionnaire, please remember to click on the 'Submit' button.

1

If you have any questions concerning the questionnaire or this project in general, please contact Salome
Chitavi PhD at [email protected] or 630-792-5977 or Barbara Braun PhD
at [email protected] or 630-792-5928 in the Department of Research, The Joint Commission.
About this questionnaire
This questionnaire consists of two major sections:
Section I. Hospital-level VTE Prevention Practices
A. VTE prevention policy and protocol in your hospital
B. VTE prevention team
C. VTE data collection and reporting
Section II. VTE Prevention Practices in General Medical and General Surgical Units
A. VTE risk assessment
B. VTE prophylaxis safety considerations
C. Ambulation protocol and VTE prevention education
D. VTE prophylaxis monitoring and support
Definitions and Key Abbreviations
For questions specific to units / services, use the following definitions:
General medical services/unit(s) includes adult patients 18 years or older. This excludes patients located
in the following units: critical care unit, sub-specialty services/units, pediatric, obstetrics and gynecology,
psychiatric, and substance abuse.
General surgical services/unit(s) includes adult patients 18 years or older undergoing surgeries that
focus on the abdomen including esophagus, stomach, small intestine, large intestine, liver, pancreas, gall
bladder, appendix and bile ducts, and often the thyroid gland (depending on local referral patterns). It may
also include patients undergoing surgery for diseases involving the skin, breast, soft tissue, trauma,
peripheral vascular surgery and hernias and perform endoscopic procedures such as gastroscopy and
colonoscopy. This section should exclude patients treated within surgical specialties such as orthopedics,
bariatrics, gynecology and pediatrics.
If your hospital has a combined medical and surgical unit and the unit typically has greater than or equal
to 50% medical patients in this unit, include in general medical unit(s). If it is less than 50% medical
patients in this combined unit, then include in surgical unit.
CDS = Clinical Decision Support
CMS = Centers for Medicare & Medicaid Services
DVT = Deep vein thrombosis
HIIN = Hospital Improvement Innovation Network
PE = Pulmonary embolism
RAM = Risk assessment model
VTE = Venous thromboembolism

2

I. HOSPITAL-LEVEL VTE PREVENTION PRACTICES
A. VTE prevention policy and protocol(s)
1. Does your hospital have a VTE prevention policy? Select one
Note: A policy is a principle or method that is developed for the purpose of guiding decisions and
activities related to governance, management, care, treatment, and services. A policy is developed
by organization leadership, approved by the governing body of the organization, and maintained in
writing. A VTE prevention policy is a formal written set of plans and actions to help prevent VTE in
hospitalized patients. A policy is distinct from a protocol which is addressed in question 5.
[ ] No, we do not have a VTE prevention policy Skip to question 3
[ ] Yes
2. Does your VTE prevention policy apply to all patients in the hospital? Select one
[ ] No, the policy does not apply to all patients
[ ] Yes,
[ ] Unknown
3. Have you experienced barriers to formulating a hospital - wide VTE prevention policy? Select one
[ ] No Skip to question 5
[ ] Yes
[ ] Unknown Skip to question 5
4. How significant were the following potential barriers in establishing a hospital wide VTE prevention
policy? Answer each of the following:
Not at all
Highly
Unknown/
significant
Neutral
significant
no opinion
1

2

3

4

5

4a. Not a hospital priority

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

4b. Lack of hospital leadership support

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

4c. Lack of a VTE prevention champion

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

4d. Lack of time or human resources

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

4e. Lack of financial resources

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

4f. Other, specify: _________________

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

5. Does your hospital have a hospital wide VTE prevention protocol? Select one
Note: A VTE prevention protocol is a standardized VTE risk assessment process, sometimes
linked to a menu of appropriate VTE prophylaxis options for level of risk, which provides guidance
for patients with contraindications to pharmacologic prophylaxis. The protocol may include
bleeding risk tools and guidance for timing of anticoagulant prophylaxis for surgical procedures.
Protocols define best local practice based on best evidence, with operational definitions that drive
order set design, measurement tools, etc.
[ ] No
[ ] Yes

3

6. Is there a unit-specific VTE prevention protocol for any of the following? Select one
[
[
[
[
[

] General medical units/wards only
] General surgical units/wards only
] For both general medical and general surgical units/ wards
] No, we do not have any unit specific protocols
] Other: specify ________________

B. VTE prevention team
7. Does your hospital or hospital system have a VTE prevention team (committee or work group)?
Select one
[ ] No Skip to question 12
[ ] Yes, we have a designated team that focuses specifically on VTE prevention
[ ] Yes, VTE is addressed by another committee, specify _________________________
8. Does the VTE prevention team (committee or work group) have representation from two or more
hospital departments? Select one
[ ] No
[ ] Yes
[ ] Unknown
9. How many people are on the VTE prevention team (committee or work group)? Select one
[
[
[
[

] 2-5
] 6-12
] 13-20
] ≥21

10. What healthcare professional(s) comprise the VTE prevention team (committee or work group)?
Check all that apply
Note: Can check dual roles. For example, if a team member has the role of officer and nurse, both
can be checked.
[
[
[
[
[
[
[
[
[

] Administrators or Officers
] Physicians
] Nurses
] Quality Improvement representative(s)
] Pharmacists
] Information Technology / Informatics
] Respiratory Therapist
] Rehabilitation Professional
] Other, specify ____________________

11. How often does the VTE prevention team (committee or work group) meet? Select one
[
[
[
[
[

] Annually
] Quarterly
] Monthly
] Weekly
] Other, specify: _____________

4

12. Has your hospital participated in a Hospital Improvement Innovation Network (HIIN) project on
improving patient safety that addressed VTE prevention? Select one
Note: As a CMS supported initiative, Hospital Improvement Innovation Networks (HIINs) work at
the regional, state, national or hospital system level to sustain and accelerate national progress and
momentum towards continued harm reduction in the Medicare program, help identify solutions
already working and disseminate them to other hospitals and providers.
[ ] No
[ ] Yes
[ ] Unknown
C. VTE data collection and reporting
13. Which, if any, of the following VTE data does your hospital currently collect over time? Check all that
apply
Note: Over time (e.g. monthly, quarterly, annually).
[ ] Number of newly diagnosed cases of hospital-associated DVT or PE that occur as a result of
hospitalization, surgery, or other healthcare treatment or procedure
[ ] Percentage of patients with a VTE risk assessment
[ ] Percentage of patients receiving appropriate VTE prophylaxis
[ ] Number of patients with bleeding events and/or complications related to anticoagulant
prophylaxis
[ ] Other, describe________________________________________________
[ ] None
14. Does your hospital review hospital-associated VTE events? Select one
Note: Examples of VTE events are DVT, PE, or sudden cardiac death due to PE
[
[
[
[

] No
] Yes, some events
] Yes, all events
] Unknown

15. Does your hospital review adverse events and complications from anticoagulant prophylaxis? Select
one
Note: Examples of adverse events and complications from anticoagulant prophylaxis include major
bleeding, such as intracerebral hemorrhage, minor bleeding, heparin-induced thrombocytopenia with
thrombosis.
[
[
[
[

] No
] Yes, some events
] Yes, all events
] Unknown

16. Does your hospital externally report VTE data to a private, state, or federal agency? Select one
[ ] No Skip to question 18
[ ] Yes
[ ] Unknown Skip to question 18

5

17. To whom is the data reported? Check all that apply
[ ] CMS Hospital Inpatient Quality Reporting (IQR) Program (e.g. electronic clinical quality
measures VTE1, VTE2 for VTE prophylaxis)
[
[
[
[

] State, specify:__________
] The Joint Commission
] Agency for Healthcare Research and Quality (e.g. PSI90, PSI12)
] Other, specify: __________

II. VTE PREVENTION PRACTICES IN GENERAL MEDICAL AND SURGICAL SERVICES/UNITS
General medical services/unit(s) includes adult patients 18 years or older. This excludes patients located
in the following units: critical care unit, sub-specialty services/units, pediatric, obstetrics and gynecology,
psychiatric, and substance abuse.
General surgical services/unit(s) includes adult patients 18 years or older undergoing surgeries that
focus on the abdomen including esophagus, stomach, small intestine, large intestine, liver, pancreas, gall
bladder, appendix and bile ducts, and often the thyroid gland (depending on local referral patterns). It may
also include patients undergoing surgery for diseases involving the skin, breast, soft tissue, trauma,
peripheral vascular surgery and hernias and perform endoscopic procedures such as gastroscopy and
colonoscopy. This section should exclude patients treated within surgical specialties such as orthopedics,
bariatrics, gynecology and pediatrics.
If your hospital has a combined medical and surgical unit and the unit typically has greater than or equal
to 50% medical patients in this unit, include in general medical unit(s). If it is less than 50% medical
patients in this combined unit, then include in surgical unit.
A. VTE risk assessment
18. Which patients are routinely assessed for VTE risk? Select one
[
[
[
[

] Patients in general medical units only
] Patients in general surgical units only skip to 19b
] Patients in both general medical and general surgical units
] Neither general medical nor general surgical but other specialty groups of patients (Skip to
question 29
[ ] None Skip to question 29
19a. Who conducts VTE risk assessment for general medical patients? Check all that apply
[
[
[
[
[

] Physician
] Nurse Practitioner/Physician Assistant
] Nurse
] Pharmacist
] Other, specify:__________________

19b. Who conducts VTE risk assessment for general surgical patients? Check all that apply
[
[
[
[
[

] Physician
] Nurse Practitioner/Physician Assistant
] Nurse
] Pharmacist
] Other, specify:__________________

6

20. Which services/units use a standardized VTE risk assessment? Select one
Note: standardized means they must follow a common protocol rather than relying on clinical
judgement
[ ] General medical only
[ ] General surgical only Skip to question 22
[ ] Both general medical and general surgical
[ ] Neither general medical nor general surgical but other specialty groups of patients
Skip to question 29
[ ] None Skip to question 29

21. When is VTE risk assessment performed on general medical patients? Check all that apply
[ ] On admission
[ ] On transfer to another unit/service or level of care
[ ] Daily or more often
[ ] On discharge from the hospital
[ ] Other, specify:__________________________ Skip to question 23a
Please answer questions 21a to 21d below as applicable depending on your selections in Q21.
21a.

Is the risk assessment on general medical patients mandatory or optional on admission? Select
one
[ ] Mandatory
[ ] Optional

21b. Is the risk assessment on general medical patients mandatory or optional on transfer to another
unit / service? Select one
[ ] Mandatory
[ ] Optional

21c. Is the daily risk assessment on general medical patients mandatory or optional? Select one
[ ] Mandatory
[ ] Optional

21d. Is the risk assessment on general medical patients mandatory or optional on discharge from the
hospital? Select one
[ ] Mandatory
[ ] Optional

7

22. When is VTE risk assessment performed on general surgical patients? Check all that apply
[
[
[
[
[

] On admission
] On transfer to another unit/service or level of care
] Daily or more often
] On discharge from the hospital
] Other, specify:__________________________ Skip to question 23b

Please answer questions 22a to 22d below depending as applicable on your selections in Q22.
22a.

Is the risk assessment on general surgical patients mandatory or optional on admission? Select
one
[ ] Mandatory
[ ] Optional

22b. Is the risk assessment on general surgical patients mandatory or optional on transfer to another
unit / service? Select one
[ ] Mandatory
[ ] Optional
22c. Is the daily risk assessment on general surgical patients mandatory or optional? Select one
[ ] Mandatory
[ ] Optional
22d. Is the risk assessment on general surgical patients mandatory or optional on discharge from the
hospital? Select one
[ ] Mandatory
[ ] Optional
23a. If you use a VTE risk assessment model for your general medical patients is it based on an
externally published risk assessment model? Select one
[ ] No, we use a standardized VTE risk assessment model for our medical patients that is not
based on an externally published risk assessment model
[ ] Yes
23b. If you use a VTE risk assessment model for your general surgical patients is it based on an
externally published risk assessment model? Select one
[ ] No, we use a standardized VTE risk assessment model for our surgical patients that is not
based on an externally published risk assessment model
[ ] Yes
24a. Which type of qualitative risk assessment model is being used for general medical patients? Select
one
Note: Qualitative risk assessment models categorize groups of patients into broad risk categories
or “buckets” of VTE risk (e.g., low, moderate, and high).

8

[
[
[
[

] We do not use a qualitative risk assessment model for general medical patients
] 3-bucket/University of California San Diego (UCSD) as published
] Modified 3-bucket, describe____________________
] Other, or internally developed consensus model specify: ________________

24b. Which type of quantitative risk assessment model is being used for general medical
patients? Select one
Note: Quantitative risk assessment models are point-based scoring systems that assign points to
each VTE risk factor based on the impact of each risk factor on VTE risk. The patient’s cumulative
point score determines the patient’s VTE risk level (e.g., low, moderate, or high).
[
[
[
[
[
[
[
[
[
[
[
[
[

] We do not use a quantitative risk assessment model for general medical patients
] Caprini (as published)
] Modified Caprini
] Kucher (as published)
] Modified Kucher
] IMPROVE Predictive (as published)
] IMPROVE Associative (as published)
] Modified IMPROVE
] Intermountain Health (as published)
] Modified Intermountain Health
] Padua (as published)
] Modified Padua
] Other, or internally developed consensus model specify: ________________

24c. Which type of qualitative risk assessment model is being used for general surgical patients? Select
one
Note: Qualitative risk assessment models categorize groups of patients into broad risk categories
or “buckets” of VTE risk (e.g., low, moderate, and high).
[
[
[
[

] We do not use a qualitative risk assessment model for general surgical patients
] 3-bucket/University of California San Diego (UCSD) as published
] Modified 3 bucket, describe ___________________
] Other, or internally developed consensus model specify: ________________

24d. Which type of quantitative risk assessment model is being used for general surgical patients?
Select one
Note: Quantitative risk assessment models are point-based scoring systems that assign points to
each VTE risk factor based on the impact of each risk factor on VTE risk. The patient’s cumulative
point score determines the patient’s VTE risk level (e.g., low, moderate, or high).
[
[
[
[
[
[
[
[

] We do not use a quantitative risk assessment model for general surgical patients
] Caprini (as published)
] Modified Caprini
] Kucher (as published)
] Modified Kucher
] IMPROVE Predictive (as published)
] IMPROVE Associative (as published)
] Modified IMPROVE

9

[
[
[
[
[

] Intermountain Health (as published)
] Modified Intermountain Health
] Padua (as published)
] Modified Padua
] Other, or internally developed consensus model specify: ________________

25a. In what format is the VTE risk assessment model implemented for general medical services/units?
Check all that apply
[ ] Electronic (with the exception of EMR downtime)
[ ] Paper
[ ] Other, specify: _____________________________________
25b. In what format is the VTE risk assessment model implemented for general surgical services/units?
Check all that apply
[ ] Electronic (with the exception of EMR downtime)
[ ] Paper
[ ] Other, specify: _____________________________________
26a. Do you systematically review information on your general medical patients’ VTE risk assessments to
monitor adherence to your VTE prevention policy and/or protocol for internal quality purposes?
Select one
[ ] No
[ ] Yes
[ ] Not applicable, we do not have a VTE prevention policy or protocol
26b. Do you systematically review information on your general surgical patients’ VTE risk assessments
to monitor adherence to your VTE prevention policy and/or protocol for internal quality purposes?
Select one
[ ] No
[ ] Yes
[ ] Not applicable, we do not have a VTE prevention policy or protocol

27. Does your hospital calculate the proportion of patients with a risk assessment completed on
admission? Select one
[
[
[
[
[

] No
] Yes, for medical patients only Skip to question 28b
] Yes, for surgical patients only Skip to question 28a
] Yes, for both medical and surgical patients Skip to Q29
] Unknown

10

28a. In your opinion, how difficult would it be to calculate the proportion of patients with a risk
assessment completed on admission for general medical patients? Select one
Not at all
difficult

Extremely
difficult

Neutral

1

2

3

4

5

[ ]

[ ]

[ ]

[ ]

[ ]

Unknown/
No opinion
[ ]

28b. In your opinion, how difficult would it be to calculate the proportion of patients with a risk
assessment completed on admission for general surgical patients? Select one
Not at all
Difficult

Extremely
difficult

Neutral

1

2

3

4

5

[ ]

[ ]

[ ]

[ ]

[ ]

Unknown/
No opinion
[ ]

B. VTE prophylaxis safety considerations
29. Which patients are routinely assessed for bleeding risk during the hospital stay?
Select one
[ ] General medical only Next answer 30a, then 31a, 32a, 33a, 33b
[ ] General surgical only Skip to question 30b, then 31b, then skip to 32b, then 33a, 33b
[ ] Both general medical and general surgical
[ ] Neither general medical nor general surgical but other specialty groups of patients
____________________ Skip to question 33a
[ ] None Skip to question 33a
30a. Who conducts the bleeding risk assessment for your general medical patients? Check all that apply
[
[
[
[
[

] Physician
] Nurse Practitioner/Physician Assistant
] Nurse
] Pharmacist
] Other, specify:__________________

30b. Who conducts the bleeding risk assessment for your general surgical patients? Check all that apply
[
[
[
[
[

] Physician
] Nurse Practitioner/Physician Assistant
] Nurse
] Pharmacist
] Other, specify:__________________

11

31a. Is the bleeding risk assessment model for your general medical patients based on an externally
published model?
Select one
[ ] No, we use an internally developed consensus model, describe _________________
[ ] Yes 32a
31b. Is the bleeding risk assessment model for your general surgical patients based on an externally
published model?
Select one
[ ] No, we use an internally developed consensus model, describe _________________
[ ] Yes 32b
32a. What is the model being used for bleeding risk assessment in your general medical services /
unit(s)? Select one
[
[
[
[

] IMPROVE
] HAS-BLED Score
] Modified version of one of the above, describe _________________
] Other, or internally developed consensus model specify:__________________________

32b. What is the model being used for bleeding risk assessment in your general surgical services /
unit(s)? Select one
[
[
[
[

] IMPROVE
] HAS-BLED Score
] Modified version of one of the above, describe _________________
] Other, or internally developed consensus model specify:__________________________

33a. Is documentation of any contraindications to anticoagulant prophylaxis required in your general
medical services/unit(s)? Select one
[ ] No
[ ] Yes
[ ] Unknown
33b. Is documentation of any contraindications to anticoagulant prophylaxis required in your general
surgical services/unit(s)? Select one
[ ] No
[ ] Yes
[ ] Unknown
C. Ambulation protocol and VTE prevention education
34a. Is there an ambulation protocol for your general medical patients? Select one
Note: An ambulation protocol institutes a process that assesses a patient’s current level of mobility

12

and generates recommendations for safe mobilization and interventions such as physical therapy,
as appropriate, to assist in increasing inpatient ambulation.
[ ] No
[ ] Yes
34b. Is there an ambulation protocol for your general surgical patients? Select one
[ ] No
[ ] Yes
35a. Is VTE prevention education, including the importance of VTE prophylaxis, provided for general
medical clinicians at least annually? Select one
[ ] No
[ ] Yes
35b. Is VTE prevention education, including the importance of VTE prophylaxis, provided for general
surgical clinicians at least annually? Select one
[ ] No
[ ] Yes
36a. Is VTE prevention education, including the importance of VTE prophylaxis, provided for general
medical patients any time during the hospitalization? Select one
[ ] No
[ ] Yes
36b. Is VTE prevention education, including the importance of VTE prophylaxis, provided for general
surgical patients any time during the hospitalization? Select one
[ ] No
[ ] Yes
D. VTE prophylaxis monitoring and support
37a. Do your admission order sets for general medical services / units address VTE prophylaxis? Select
one
[ ] No, our admission order sets do not address VTE prophylaxis
[ ] Not applicable, no admission order sets
[ ] Yes, completion is optional
[ ] Yes, completion is mandatory
[ ] Unknown
Comments: ______________________________________

13

37b. Do your transfer order sets for general medical services / units address VTE prophylaxis? Select
one
[ ] No, our transfer orders sets do not address VTE prophylaxis
[ ] Not applicable, no transfer order sets
[ ] Yes, completion is optional
[ ] Yes, completion is mandatory
[ ] Unknown
Comments: ______________________________________
37c. Do your admission order sets for general surgical services / units address VTE prophylaxis? Select
one
[ ] No, our admission order sets do not address VTE prophylaxis
[ ] Not applicable, no admission order sets
[ ] Yes, completion is optional
[ ] Yes, completion is mandatory
[ ] Unknown
Comments: ______________________________________
37d. Do your transfer order sets for general surgical services / units address VTE prophylaxis? Select
one
[ ] No, our transfer orders sets do not address VTE prophylaxis
[ ] Not applicable, no transfer order sets
[ ] Yes, completion is optional
[ ] Yes, completion is mandatory
[ ] Unknown
Comments: ______________________________________
38a. Are clinical decision support tools provided to help guide the selection of appropriate VTE
prophylaxis for general medical patients? Select one
Note: Clinical decision support (CDS) can be provided electronically and/or paper form and/or by
human alert. Electronic CDS are implemented in many platforms (e.g., Internet-based, local
personal computer, networked EMR, or a handheld device). Common features of CDS designed
to provide patient-specific guidance include the knowledge base (e.g., compiled clinical
information on diagnoses, drug interactions, guidelines), a program for combining this with
patient-specific information, and a communication mechanism.
[ ] No
[ ] Yes
38b. Are clinical decision support tools provided to help guide the selection of appropriate VTE
prophylaxis for general surgical patients? Select one
[ ] No
[ ] Yes

14

39a. Is VTE prophylaxis monitoring and support integrated into quality and safety checklists or reviews /
reports for patients on general medical units? Select one
[ ] No
[ ] Yes
39b. Is VTE prophylaxis monitoring and support integrated into quality and safety checklists or reviews /
reports for patients on general surgical units? Select one
[ ] No
[ ] Yes
40a. Are reminders, such as electronic and/or human alerts, provided for general medical patients?
Select one
Note: Reminders and electronic/human alerts are additional interventions reinforcing the protocol to
drive improved care. For example, a physician can receive electronic/computer alerts or human
alerts (e.g., phone call from a nurse or pharmacist) when their patient has not had VTE risk
assessment done or appropriate prophylaxis ordered.
[ ] No
[ ] Yes
40b. Are reminders, such as electronic and/or human alerts, provided for general surgical patients?
Select one
[ ] No
[ ] Yes
41a. Are audits and feedback related to VTE prophylaxis performed for general medical patients? Select
one
Note: Audit and feedback, defined as the provision of clinical performance summaries to healthcare
providers and organizations, is a well-used approach to support clinical behavior change.
[ ] No
[ ] Yes
41b. Are audits and feedback related to VTE prophylaxis performed for general surgical patients? Select
one
[ ] No
[ ] Yes
42. Are missed anticoagulant prophylaxis doses routinely documented? Check all that apply
[ ] Yes, we routinely document missed anticoagulant doses for general medical patients Skip
question 43a If only medical is selected
[ ] Yes, we routinely document missed anticoagulant doses for general surgical patients Skip to
question 43b if only surgical is selected
[ ] No, we do not routinely document missed anticoagulant doses for general medical or
general surgical patients Skip to question 44

15

43a. Are the reasons for missed doses documented for general medical patients? Select one
[
[
[
[

] No
] Sometimes
] Most of the time
] Always

43b. Are the reasons for missed doses documented for general surgical patients? Select one
[
[
[
[

] No
] Sometimes
] Most of the time
] Always

44. In the space provided below, please feel free to provide additional information on VTE prevention
activities currently in progress at your organization or plans for future activities.
__________________________________________________________________________________
__________________________________________________________________________________

You have reached the end of this questionnaire. Thank you very much for taking the time to provide us
with the information requested. Your participation is a significant contribution to efforts to improve VTE
prevention practices.
If you would like to make edits to your previous answers, please select the back arrow below. Please also
note that because this questionnaire did not require any forced responses, you may have skipped some
questions. At this time consider going back to answer any of the questions that you previously skipped.
When everything is complete, please click the 'Submit' button. If you have any questions concerning this
process please email Salome Chitavi, [email protected].

16