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

2. 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

3. 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

4. VTE prevention: a global initiative

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

6. 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

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

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

14. Introduction of computer system

15. 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

16. 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

17. 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

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

19. 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

20. VTE Exemplar Centres

21. Exemplar centres: education and awareness
Local activities and training
E-learning modules
e-Learning for Healthcare VTE module: in progress
Lecturing at national courses on thromboprophylaxis:
Hertfordshire & Birmingham
NHS Choices: video on DVT

22. 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 the ICC, Birmingham
Workshops for nurses and pharmacists planned

23. VTE exemplar centre website www.kingsthrombosiscentre.org.uk

24. 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