What still needs to be achieved in the clinical situation? VTE Symposium – sharing good practice 21 st September 2010 Dr Tamara Everington

1. Doctor 2. Nurse 3. Pharmacist 4. Risk Manager 5. Executive 6. Other What is your background?

NICE Quality Standard 1  “All patients, on admission, receive an assessment of VTE and bleeding risk”

How do we crack the last 10%?

Which 1 of these do you think is most likely to increase compliance with VTE risk assessment? 1. CQUINS targets 2. Executive Drivers 3. Better staff education 4. Electronic Systems 5. Productive Wards

NICE Quality Standard 2  “Patients are re-assessed within 24 hours of admission for risk of VTE and bleeding”

How should you document repeat VTE RA at 24 hours? 1. Repeat the initial VTE RA document 2. Document in the clinical pathway (PTWR) 3. Pharmacy check 4. Nurse check 5. Other

NICE Quality Standard 3  “Patients assessed to be at risk of VTE are offered VTE prophylaxis in accordance with NICE guidance”

Which groups would you adjust thromboprophylaxis dose in? 1. Renal impairment 2. Obesity 3. Cancer patients with cachexia 4. Recurrent “fallers” 5. All of the above 6. None of the above

Which day cases do you plan to risk assess? 1. Day surgery under GA 2. Day surgery under LA 3. Fracture clinic 4. Chemotherapy patients 5. Medical day cases 6. 1,(2), 3 & 4 7. All of the above

In theory we could reduce secondary VTE by 65%?

How will you pick up secondary VTE? 1. Via anticoagulant referrals 2. Via radiology reports of VTE 3. Via clinical coding 4. Via death certificates 5. Via the Coroner 6. Combination of the above?

NICE Quality Standards 4 & 5  “Patients / carers are offered verbal and written information on VTE prevention at time of admission…. & as part of the discharge process”

If only!!! Simples!!!!

What information is most likely to work? 1. Written information 2. Visual information 3. Face-to-face explanation 4. A mixture of the above

NICE Quality Standard 6  “Patients provided with anti-embolism stockings have them fitted and monitored in accordance with NICE guidance”

Which of the following have you seen on patients? 1. Which of the following have you seen on patients? 2. Stockings causing a ‘tourniquet’ effect 3. Damaged legs from stockings 4. Soiled stockings 5. All of the above 6. “I wish you hadn’t asked that question”

NICE Quality Standard 7  “Patients receive extended postoperative VTE prophylaxis in accordance with NICE guidance”

A 65 year old woman with a history of VTE has incurable ovarian cancer with reduced mobility which can be controlled with indefinite chemotherapy. How long would you continue thromboprophylaxis? 1. Not at all 2. Aspirin only 3. For 28 days following surgery 4. Indefinitely

Root cause analysis – How do we do this?

Which method of RCA do you think will be most effective? 1. RCA by the Thrombosis Committee 2. RCA by the VTE nurse 3. RCA by Clinical risk 4. RCA by Clinical teams