1. Mandatory Training: VTE prevention and anticoagulation practice Mandatory Training: VTE prevention and anticoagulation practice Mr A McSorley Lead Thrombosis Nurse RCHT

2. - Risk assessment and VTE avoidance -RCA of hospital acquired VTE (HAT) -Thrombosis & anticoagulation guidance - Risk assessment and VTE avoidance -RCA of hospital acquired VTE (HAT) -Thrombosis & anticoagulation guidance

3. Venous Thrombo-Embolism (VTE)  VTE is a major public health Issue & results in approximately 60,000 deaths per year in the UK  VTE causes more deaths than breast cancer, RTAs and AIDS combined and 5 times the number of deaths from HAI’s (MRSA / C.Diff)  The total cost (direct & indirect) of managing a VTE is £640 million 1 in 3 people with a DVT  1 in 3 people with a DVT (Deep Venous Thrombosis) will develop post-thrombotic symptoms within 3 years & 25% will develop a VLU later in life  25,000 die from a hospital acquired VTE every year 1  4 out of 5 DVTs are undetected as their symptoms mimic other conditions

4. Your Responsibility (c/f AC policy) 5.6. Role of Individual Staff Members All Staff are responsible for: Taking positive steps to ensure the appropriate patient VTE assessment is completed accurately. Taking positive steps to ensure the appropriate patient VTE assessment is completed accurately. Ensuring any actions identified through monitoring and evaluations are undertaken. Ensuring any actions identified through monitoring and evaluations are undertaken. Ensuring that any incidents linked with VTE assessment, prophylaxis or management are reported using the Trust’s incident reporting procedure Ensuring that any incidents linked with VTE assessment, prophylaxis or management are reported using the Trust’s incident reporting procedure

5. Avoiding hospital related Venous thrombo-embolism (VTE): target >95% recorded initial risk assessment with monthly submission % to the DoH target >95% recorded initial risk assessment with monthly submission % to the DoH CQUIN so RCHT received 2012-13 ~£0.3M CQUIN so RCHT received 2012-13 ~£0.3M 2013-4 RCA of hospital acquired VTE £0.11M 2013-4 RCA of hospital acquired VTE £0.11M

6. Assessment on admission (1) and at 24 hrs (2) (June 2011) Assessment on admission (1) and at 24 hrs (2) Thrombosis prevention and anticoagulation policy (June 2011)

7. RCH-T Schema STEP FOUR – Document appropriateness of thrombo- prophylaxis Assess and decide on the appropriateness of thromboprophylaxis Assess and decide on the appropriateness of thromboprophylaxis Tick complete the Risk Assessment Decision and Action box on admission to column 1 on the bottom of the prescription sheet, Tick complete the Risk Assessment Decision and Action box on admission to column 1 on the bottom of the prescription sheet,

8. Monthly pharmacy audit

9. EPMA: the problem and the answer Currently requires a 4 page supplementary sheet, with RA on back page Currently requires a 4 page supplementary sheet, with RA on back page Module due with Feb 2014 upgrade Module due with Feb 2014 upgrade Your support please Your support please

10. Thrombosis Practitioner/facilitator Support the Risk assessment process HAT RCA -from July 2013 as part of CQUIN -reports to Divisions (via DQLG) DoH quality standards patient information Peri-operative anticoagulation Anticoagulation related bleeding

11. RCA to date Q2 = 90 RCA, preventable HAT = 13 Q2 = 90 RCA, preventable HAT = 13 Q3 = 112 RCA, preventable HAT = 11 Q3 = 112 RCA, preventable HAT = 11 Emerging themes/causes of HAT Emerging themes/causes of HAT –Failure to prescribe AES for patients not suitable or unwilling for LMWH –Failure to initiate LMWH or omission of doses – EPMA issue?? –Failure to provide AES when LMWH stopped for intervention

12. Clinical Guideline For Thrombosis Prevention Investigation And Management Of Anticoagulation Venous thrombo-embolism Venous thrombo-embolism –Risk assessment Therapeutic anticoagulation Therapeutic anticoagulation –investigation, therapy and duration –cancer Complications Complications –bleeding Special circumstances Special circumstances –Surgery –Thrombophilia investigation –Pregnancy