Preventing VTE in hospitalised patients Dr Roopen Arya King’s College Hospital

Preventing VTE in hospitalised patients Hospitalised patients at high risk of VTE VTE leads to substantial cost, mortality and morbidity Effective, safe and cost-effective measures to prevent hospital-acquired VTE exist Roadmap is in place Gap between current practice and optimal practice remains large Summary AHRQ report, 2008

Thrombosis prevention in the UK Mar 2005 House of Common Health Committee Report April 2007 Independent Expert Working Group report NICE guidance re: surgical patients National VTE Implementation Working Group established Sept 2007 National VTE Exemplar Centre network launched Sept 2008 National VTE risk assessment tool published Sept 2009 NICE guidance re: all hospitalised patients

VTE prevention: a global initiative

Implementing national VTE guidance: progress Implementation Working Group Exemplar Centres Thrombosis committees: local guidelines Thrombosis teams VTE Risk assessment

VTE Implementation Working Group Established by CMO A Thomas (Chair), R Arya, T Baglin, A Flowerdew, A Kakkar, E Nicol, T Brown (Coordinator) Provide oversight and leadership for implementation of national VTE strategy in the NHS and wider healthcare sector Work closely with stakeholders such as NICE and HCC to ensure risk assessment of all hospitalised patients

VTE Implementation Working Group Develop a national VTE risk assessment tool Develop Exemplar Centres Raising awareness Education

Prevention of VTE in hospitalised patients: Documented risk assessment for all hospitalised patients

http://healthguides.mapofmedicine.com/

Introduction of computer system

VTE prevention: ‘real-world practice’ ENDORSE survey: (2008) 52% patients at risk for VTE 50% receiving prophylaxis (surgical 59%; medical 40%) APPTG survey:(APPTG 2nd Annual Audit, 2008) 99% acute Trusts were aware of CMO’s recommendations and NICE guideline 70% undertaking ‘documented mandatory risk assessment’ 86% have thrombosis committees 87% educate staff re: risk of VTE VERITY survey: 94% have thrombosis committees >80% have guidelines for medical and surgical thromboprophylaxis <10% to 95% patients risk assessed for VTE 1 in 8 using DH VTE risk assessment

VTE Exemplar Centres Resource for demonstration of best practice Based within hospitals or networks with an existing track record of excellent VTE management Expanded role including quality control, audit and education Help develop national risk assessment strategy, audit tools, centralised educational material to support local programmes King’s College Hospital was first NHS exemplar centre & the London Clinic in the independent sector Network of exemplar centres being developed: 8 exemplar centres at end of 2008

VTE Exemplar Centres: Requirements Chief Executive agreement / support Mechanism in place for VTE risk assessment Audit trail – evidence of prevention management across organisation Multidisciplinary team approach Education and raising awareness re: VTE Ability to act as a resource to spread good practice To apply e-mail: roopen.arya@kcl.ac.uk

VTE exemplar centres: main elements Thrombosis committees Thrombosis teams Implementation of VTE risk assessment and thromboprophylaxis Audit Education and awareness Clinical research into VTE

VTE exemplar centres in action: Models of care: Excellence at prevention of VTE in hospitalised patients Comprehensive care of VTE VTE prevention in the community Exemplars will include: NHS Hospital Trusts Primary Care Trusts Strategic Health Authorities Independent sector

VTE Exemplar Centres

Exemplar centres: education and awareness Local activities and training E-learning modules http://www.elearning-essexrivers.co.uk http://doctors.net.uk/education e-Learning for Healthcare VTE module: in progress Lecturing at national courses on thromboprophylaxis: Hertfordshire & Birmingham NHS Choices: video on DVT http://www.nhs.uk/video

Exemplar centres: education and awareness Meetings and workshops: VTE awareness symposium at the London Clinic 26th Sept 2008 - First national VTE exemplar centre study day 18th March 2009 at the Royal Society of Medicine VTE, a key patient safety issue: Patient Safety Congress 1st May 2009 @ the ICC, Birmingham Workshops for nurses and pharmacists planned

VTE exemplar centre website www.kingsthrombosiscentre.org.uk

What will success look like? Developing a systems-based approach to the prevention of VTE in hospitalised patients Patient admitted to hospital What will success look like? Professional workforce aware of VTE risk Individual patient risk assessed for VTE Appropriate preventative strategy implemented Evaluation of outcome