1. VTE prevention and anticoagulation practice VTE prevention and anticoagulation practice Mr A McSorley Lead Thrombosis Nurse RCHT

2. - Risk assessment and VTE avoidance -RCA of hospital acquired VTE (HAT) -Thrombosis & anticoagulation guidance

3.  VTE is a major public health issue & results in approx. 60,000 deaths per year in UK  VTE causes more deaths than breast cancer, RTAs and AIDS combined and 5 times the number of deaths from HAI’s (MRSA / C.Diff)  The total cost (direct & indirect) of managing a VTE is £640 million  1 in 3 people with a DVT (Deep Venous Thrombosis) will develop post-thrombotic symptoms within 3 years & 25% will develop a VLU later in life  25,000 die from a hospital acquired VTE every year 1  4 out of 5 DVTs are undetected as their symptoms mimic other conditions

4. Your Responsibility (c/f AC policy) 5.6. Role of Individual Staff Members All Staff are responsible for: Taking positive steps to ensure the appropriate patient VTE assessment is completed accurately. Ensuring any actions identified through monitoring and evaluations are undertaken. Ensuring that any incidents linked with VTE assessment, prophylaxis or management are reported using the Trust’s incident reporting procedure

5. Avoiding hospital related Venous thrombo- embolism (VTE): target >95% recorded initial risk assessment with monthly submission % to the DoH CQUIN so RCHT received 2012-13 ~£0.3M 2013-4 RCA of hospital acquired VTE £0.11M

6. Assessment on admission (1) and at 24 hrs (2) (June 2011) Assessment on admission (1) and at 24 hrs (2) Thrombosis prevention and anticoagulation policy (June 2011) Assessment on admission and at 24 hrs (2) Thrombosis prevention and anticoagulation policy (June 2011 )

7. Monthly pharmacy audit

8. VTE risk assessment on EPMA You Tube video demonstration ‘real time’ reporting of mis-match between VTE risk assessment and actual prescription Planned report feed to ward for handovers No longer use EPMA forms from 24 th March unless for fluids/infusions

10. Thrombosis Practitioner/facilitator Support the Risk assessment process HAT RCA -from July 2013 as part of CQUIN -reports to Divisions (via DQLG) DoH quality standards patient information Peri-operative anticoagulation Anticoagulation related bleeding

11. RCA to date Q2 = 90 RCA, preventable HAT = 13 Q3 = 112 RCA, preventable HAT = 11 Q4 = 12 to date Emerging themes/causes of HAT Failure to prescribe AES for patients not suitable or unwilling for LMWH Failure to initiate LMWH or omission of doses – EPMA issue?? Failure to provide AES when LMWH stopped for intervention

12. Prescribing AES in EPMA Nurses can prescribe AES under group protocol Available under POE on EPMA Select ‘patient’ then search for ‘ANTIE’ (NOT TEDS) Will populate with a STAT and ongoing dose automatically

13. Clinical Guideline For Thrombosis Prevention Investigation And Management Of Anticoagulation Venous thrombo-embolism –Risk assessment Therapeutic anticoagulation –investigation, therapy and duration –cancer Complications –bleeding Special circumstances –Surgery –Thrombophilia investigation –Pregnancy