Presentation on theme: "Working together to achieve nursing excellence in VTE Katrina Glaister Clinical Governance Facilitator (VTE Project Nurse) Salisbury NHS Foundation Trust."— Presentation transcript:
Working together to achieve nursing excellence in VTE Katrina Glaister Clinical Governance Facilitator (VTE Project Nurse) Salisbury NHS Foundation Trust
VTE prophylaxis in Salisbury Who are we? Where we were Where we are now Top tips!
Salisbury NHS Foundation Trust 500 beds. 200, 000 people locally Specialist services to 3 million people Spinal Unit services to 11 million people.
Where we were ….. July 2007 Policy VTE Working Group Aim: to develop a simple (evidence based) tool to assess VTE risk, implement and measure progress (improvement)
Where we are now….. Demonstrated sustained improvement - Exemplar site VTE nurse (part time) VTE policy – Trust-wide Risk assessment + patient self-assessment Audit +++ Education, education, education Patient information Thrombosis Committee
VTE Risk Assessment Local practice Aim - one tool Orthopaedics, palliative care, plastics, haematology & urology Orthopaedics (oral prophylaxis)
Risk Assessment – documentation Wanted it simple! Audit Who assesses in Salisbury? Surgery – nurses Medicine – doctors Either way, nurses are key
VTE prophylaxis Low risk = advice only High risk = fixed dose low molecular weight heparin (LMWH) unless contraindicated (if so then GCS if OK) If high risk + history of previous VTE - LMWH plus GCS
Can patients self-assess? Outpatients in: Fracture clinic, Day Surgery, Oncology Can patients self-assess? Outpatients in: Fracture clinic, Day Surgery, Oncology
Audit Pharmacists central to our success Trust-wide audit Reporting: Celebrated good practice League tables Clinical Governance newsletters Published article
Education & raising awareness Staff 1:1, ward-based, awareness days, symposium, Clinical Governance Sessions, screen saver, Hospital Rounds, Junior Doctors, Physiotherapists, M&M meetings, feedback from incidents, RCA for all secondary VTE events …. Patient stories Patients are key! Governor on Thrombosis Committee, DVD, written information, plasma screens, Patientline/Hospedia, Foundation Constituency meetings, Annual Review article, Health Fairs, AGM ……. Message is : Get out of bed ASAP Exercise if on bed-rest Take deep breaths Stay hydrated.
An informed public? Terminology – the general public vaguely understand what DVT is, but not VTE From a member of public at a Wiltshire Health Fair “VTE is the thing you get on a plane or when you have an operation and three weeks later you die”
An informed public? I've heard of a DVT – what is a VTE? Is VTE the new buzz word? Is VTE a breakfast cereal? - I've heard of DVT - a pain in the leg!' I still call it DVT - never heard of VTE Never heard of VTE - is it when you have thick blood? They changed it did they? I knew DVT! I've had 3 DVTs - I wouldn't know VTE - I had sticky blood as part of Lupus
Educating patients Written patient information: Average reading age in UK is around 11 years Health literacy is recognised as a problem in UK and elsewhere Coming into hospital patients are given many information sheets – do they read them? “Oh yes, I did get one of those, I sent it home with the wife, she’s much more interested in that sort of thing than me”
Information must be accessible
1 = Policy approved, 2 = Policy launched, 3 = Audit data presented to wards as league tables, 4 = Intensive education & link nurse programme, 5 = Executive drivers & pharmacy mandate (no RA = no drugs)
Deaths with VTE at Salisbury Oct 07 - Mar 08 Apr 08 - Sep 08 Oct 08 - Mar 09 Apr 09- Sep 09 number of deaths Deaths with VTE Deaths from VTE
20 secondary VTE, 5 PE* Oct 09-date
VTE in the Southwest
Top tips Patient stories are a powerful learning tool/motivator Regular early reinforcement about VTE ‘at the coal face’ ensures that risk assessment is embedded Build ‘change’ into normal practice Audit – essential and time consuming – IT helps! Semi-competitive ‘league tables’ increase compliance Provide VTE outcome data directly to staff Executive endorsement ensures that work progresses Work in progress, there is more to do!