1. Insert name of presentation on Master Slide Hospital Acquired Thrombosis Simon Noble and Mike Fealey

2. October 2000 28-year old woman dies from pulmonary embolism shortly after arrival at Heathrow airport, after a 20-hour journey from Australia The political climate Hospital Acquired Thrombosis

3. Overview In the UK between 25,000 and 32,000 patients die as a result of PE following DVT Equates to 1,250 avoidable deaths In 2005 this figure was more than the combined deaths from –Breast Cancer –AIDS –RTAs 25 times greater than annual MRSA deaths Hospital Acquired Thrombosis

4. Position in Wales Hospital Acquired Thrombosis

5. NICE Guidance Venous thromboembolism prevention quality standard Statement 1. All patients, on admission, receive an assessment of VTE and bleeding risk using the clinical risk assessment criteria described in the national tool.Statement 1 Statement 2. Patients/carers are offered verbal and written information on VTE prevention as part of the admission process.Statement 2 Statement 3. Patients provided with anti-embolism stockings have them fitted and monitored in accordance with NICE guidance.Statement 3 Statement 4. Patients are re-assessed within 24 hours of admission for risk of VTE and bleeding.Statement 4 Statement 5. Patients assessed to be at risk of VTE are offered VTE prophylaxis in accordance with NICE guidance.Statement 5 Statement 6. Patients/carers are offered verbal and written information on VTE prevention as part of the discharge process.Statement 6 Statement 7. Patients are offered extended (post hospital) VTE prophylaxis in accordance with NICE guidance.Statement 7 In addition, quality standards that should also be considered when commissioning and providing a high-quality VTE service are listed in related NICE quality standardsrelated NICE quality standards Hospital Acquired Thrombosis

6. Challenges to good practice Complex concept to empower patients with Complex patient pathway Not all clinicians signed up to recommendations Hospital Acquired Thrombosis

7. Prophylaxis doesn't improve mortality in medical patients NICE sits in the pocket of pharma Lifeblood sits in the pocket of pharma NICE guidelines are not evidence based

8. Discussion – So which patients are more at risk? Hospital Acquired Thrombosis

9. Discussion – So which patients are more at risk? Hospital Acquired Thrombosis Overweight Old age Oncology Obstetric On-going medical condition Operation – those patients having surgery

10. Age But HAT is complicated sometimes - Risk of Thrombosis Thrombosis threshold adapted from Rosendaal. Lancet. 1999 Hospital Acquired Thrombosis

11. Obese Age Risk of Thrombosis Thrombosis threshold adapted from Rosendaal. Lancet. 1999 Hospital Acquired Thrombosis

12. Obese Age Pregnancy Risk of Thrombosis Thrombosis threshold adapted from Rosendaal. Lancet. 1999 Hospital Acquired Thrombosis

13. Obese Age Pregnancy Caesarean Risk of Thrombosis Thrombosis threshold adapted from Rosendaal. Lancet. 1999 Hospital Acquired Thrombosis

14. Health and Social Care Committee Hospital Acquired Thrombosis

15. Conclusions Adherence to NICE guidelines essential Concern regarding reluctance to adhere Recommend development of HAT rate Recommend Root Cause Analysis Betsi Cadwaladr are wonderful Recommend Tier 1 priority Formalisation of risk assessment Hospital Acquired Thrombosis

16. Recommendations 1.Tier 1 priority 2.Mandate risk assessment and thromboprophylaxis 3.Develop standardised HAT rate 4.Root Cause Analysis 5.Increase clinician and public awareness Hospital Acquired Thrombosis

17. Welsh Government Response HAT to become “Tier 1” measure Set up Steering Group to advise 1000 Lives plus to take the lead First step to establish measurable outcomes standards by which to assess performance Development of education strategy Hospital Acquired Thrombosis

18. Current situation Definition agreed Measures agreed –Number of Hospital Acquired Thromboses per calendar month of which –Number of Root Cause Analysis completed –A summary of learning and actions Asked to set up a system that reports HAT related learning from Mortality Reviews When Medical Examiners are in place, develop a system that reports HAT related learning from their role. Hospital Acquired Thrombosis

19. Current situation RADis developers engaged Awareness campaign –Links with Lifeblood –National Thrombosis Week, May 2014 Hospital Acquired Thrombosis

20. Can you help? What mediums could we use? Where could we display / promote the campaign? Do you have any ideas? Catchy slogan? 10 min discussion Ideas via email Hospital Acquired Thrombosis

21. Areas to consider next  How to measure risk assessment compliance  How to measure appropriate prophylaxis  Minimum features in RCA Hospital Acquired Thrombosis

23. What can you do Get involved! Spread the word! Bust the myths! Hospital Acquired Thrombosis

24. Further support Mike.fealey@wales.nhs.uk Mobile - 07970 614968 Hospital Acquired Thrombosis