1. The Thrombosis Committee: an Instrument for Governance & Change
Dr Roopen Arya
King’s College Hospital, London

3. Health Committee recommendations 2005
Thrombosis committee should be established in each hospital, with a specialist thrombosis team.
Modelled on existing Blood Transfusion teams and committees.
A basic standard of expectation should be issued by the DOH pending publication of NICE guidelines.

4. Health Committee recommendations 2005
Thrombosis Committee: all interested parties including haematologists, surgeons, physicians, anaesthetists, obstetricians, nursing staff and pharmacists.
Ensure clinical governance and provide a local audit of thromboprophylactic procedures in each hospital.

5. Health Committee recommendations 2005
A potential draft remit of the Thrombosis Committee:
Promote best practice through local protocols based on national guidelines.
Lead multi-professional audit of the use of thromboprophylaxis focusing on specialties where risk is high.
Promote education and training of all clinical and support staff.
Have the authority to modify existing VTE and risk assessment protocols and to introduce appropriate changes to practice.
Consult with local patient representative groups where appropriate.
Contribute to the development of clinical governance.

6. Health Committee recommendations 2005
Thrombosis Teams would:
Assist in implementation of Thrombosis Committee’s objectives.
Promote and provide advice and support re: appropriate thromboprophylaxis and risk assessment.
Actively promote implementation of good thromboprophylaxis practice.
Be a source for training all hospital staff involved in dealing with patients at risk of VTE.

7. King’s’ experience Anticoagulation/thrombosis committee
Established 1999,
quarterly meetings
Multidisciplinary group: physicians, surgeons, imaging drs and technicians, nurse specialists, pharmacists
Instrument for clinical governance and
driving change

8. Background Adverse incidents related to anticoagulation
Awareness of mortality & morbidity due to VTE at King’s
‘Ad hoc’ management of clinical thrombosis
Practice variations and lack of clear guidelines
Manage change - new anticoagulants and treatment strategies

9. Setting up a thrombosis committee:
Identify stakeholders within Trust
Multidisciplinary core group + invite relevant parties
Terms of reference
Resource implications
Decide on agenda: be focused

10. Agenda items DVT and PE care pathways New anticoagulant drugs
Choice of LMWH
Thrombolysis for PE
Thromboprophylaxis for surgical patients
Thromboprophylaxis for medical patients
Anticoagulation prescription charts
Audit of anticoagulation & thromboprophylaxis
Adverse incidents relating to anticoagulation

11. Achievements Establishment of clinical thrombosis services
Policies for thromboprophylaxis and treatment of VTE
Policies regarding anticoagulation
Trustwide consensus & clinical guidelines
Promote clinical research
Resource for education and training
Vital part of the Trust framework for clinical governance & audit

12. Integrated Care Pathway for DVT

13. KCH guidelines for medical thromboprophylaxis