1. VTE Education, Education, Education!
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VTE Education, Education, Education!
Colchester Hospital University NHS
Foundation Trust
J Cronin, S Majeed, E Morley-Smith, K Ganesh, S Ambrozie,
M Wood, A Howard.

2. The Problem

3. Numerous Reports of Poor Prophylaxis
Canada
USA UK
Australia & NZ
- Belch et al 1981
- Conti & Daschbach 1982
- Jones 1991
- Fletcher et al 1992
- Stephens et al 1995
- Audet et al 1998
- Bratsler et al 1998
- George et al 1998
- Alizadeh & Hyman 2005

4. Questionnaire Audit of Surgical Doctors Charing Cross and Hammersmith Hospitals 2002
Aims - Assess prescription activities of surgical doctors for DVT prophylaxis
Questionnaire questions
Response rate % (n=55)
Howard et al EVF 2003

5. Doctors
Howard et al EVF 2003

6. Surgical Speciality

7. Doctors Prescribing Prophylaxis
Howard et al EVF 2003

8. Source of Information
Howard et al EVF 2003

9. Uncertainty of Prophylaxis Amongst Doctors 91%
Howard et al EVF 2003

10. Thromboembolic Risk Assessment
3 Case Scenarios
High VTE risk (n=2)
Moderate VTE risk (n=1)
45% correct risk given
69% prescribed heparin & stockings
96% approved of a single prophylaxis protocol
Howard et al EVF 2003

11. Education and Awareness Programme CXH 2002
Lectures to all surgical HO’s and SHO’s
Presentations to all surgical departments (twice)
New hospital consensus and protocol

12. AUDIT OF CXH PROTOCOL Urology, GIT, Vascular and Breast Surgery

13. 2006 Audit of Compliance With Hospital Single Protocol
Only 60 patients = 19% [95% CI 14-23%]
n = 324

14. Failure of Prophylaxis Application
233 patients
Failed to receive GCS
(72%)
151 patients
Failed to receive LMWH
(47%)

15. Lessons Learnt!
Sporadic education and audit does not maintain compliance in VTE
Why?
Silent disease until its too late
Prevention is not exciting

16. How Can The
Situation
Be Improved?

17. Effective Strategy Multifacted Evidence-based protocols Education
Risk assessment protocol
Computerised decision support
Audit with feedback
Specific staff for implementation

18. New Programme 2008 Colchester Hospital University NHS Foundation Trust
New Trust guidelines
Online risk assessment tool
e-learning and education programme
New Drug charts
Thrombosis committee
Audit all Trust inpatients (pre-launch & ‘rolling’)
Electronic alerts

19. VTE CHUFT Website

20. Laminated Handbook

22. Education on Risk is Complex - Online Risk Assessment Tool
Patient details and date of admission
VTE risk factors
Contraindications to prophylaxis
Bleeding risk with LMWH
Printed version -> case notes

25. Education & Awareness Programme
E-learning assessment (
F1 and F2 teaching sessions
Nurse patient safety teaching sessions
Grand rounds
Clinical governance half-days
Electronic alerts in clinical areas

26. Education & Awareness Programme
E-learning assessment (
70% pass mark
Certificate of completion

27. Education & Awareness Programme
E-learning assessment results
45 completed – 44 doctors, 1 nurse
F1= 23, F2= 19, SpR = 2
25/45 achieved 70% on first attempt
43/45 have completed (range 2-4 attempts)

28. ‘Audication’ in VTE Audit and vascular surgical department
15 patients audited per week
Immediate feedback of results on ward-rounds
Hospital league table on intranet page/posters

29. ‘Audication’ in Infection Control
Hand Hygiene Officer
20+ surgical patients per week
Immediate feedback of results on ward-rounds
Surgical league table on infection control board

30. The Clean Practice Protocol Educational Poster

31. ‘Audication’ Rounds 1 & 3

32. Hand Washing Round 1 & 3
n=182

33. The Next Steps

34. Patient Education ‘Stop the Clot’ campaign
Patient information with hospital TCI letter
Focus Groups
Media help

35. Maintaining Practice
Maintenance of prophylaxis and risk assessment compliance
Continued education and awareness
Appointment of DVT Nurses for Prophylaxis and Treatment
Clinical Governance sessions
E-learning assessment study
Improve patient education and awareness

36. Education, Education!
Audication?

37. Mr Adam Howard Dept of Vascular and Laparoscopic Surgery
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