Peter Davies Senior Pharmacist

 Venous thromboembolic prevention is a DH patient safety priority  NICE clinical guideline venous thromboembolism reducing the risk  CQUIN  The NHS standard contract for acute services and VTE prevention

 VTE risk assessment audit  Clinical incident/Pharmacy intervention monitoring  Healthcare record audit  Root cause analysis of hospital acquired thrombosis  Rivaroxaban use in elective THR and TKR

 Audit data since June 2008  Data collected from the front of the drug administration and record chart  3 monthly data until May 2010 now monthly  CQUIN requirements

 Reporting forms adapted to include fields to record incidents and interventions relating to VTE prevention and prophylaxis  Report generated by clinical risk and sent monthly to the thrombosis committee

 Data provided by individual wards  Audit of 5 sets of healthcare records  Record data on whether risk assessment and thromboprophylaxis is appropriate on an electronic data collection form  Data collated by clinical audit and forwarded to the Thrombosis committee

 Hospital acquired thrombosis detected by DVT/Anticoagulant clinic Coding Diagnostics Autopsies  Subjected to a root cause analysis  Reviewed by the Thrombosis committee

 For elective Primary THR or TKR  First dose 30 hours post surgery  14 days for TKR and 35 days for THR  Contra-indicated e-GFR <30ml/min  Not used if on long term anticoagulant

Documented bleeding episodes resulting in rivaroxaban being stopped/omitted Number of episodes Wound oozing/bleeding 4 GI bleed2 Haematuria in catheterised patient1 Bleed from drain 2

Off-label use of rivaroxaban Number of patients Revision of TKR3 Revision of THR3 Patella resurfacing2 Hip resurfacing 2 Uni-compartment knee replacement2 Fractured neck of Femur leading to THR1