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vte education education education

This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • In Slide Show, click on the right mouse button
  • Select “Meeting Minder”
  • Select the “Action Items” tab
  • Type in action items as they come up
  • Click OK to dismiss this box
  • This will automatically create an Action Item slide at the end of your presentation with your points entered.

Colchester Hospital University NHS

Foundation Trust

VTE Education, Education, Education!

J Cronin, S Majeed, E Morley-Smith, K Ganesh, S Ambrozie,

M Wood, A Howard.

numerous reports of poor prophylaxis
Numerous Reports of Poor Prophylaxis

Canada

USA

UK

Australia & NZ

UK

USA

USA

UK

USA

- 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

questionnaire audit of surgical doctors charing cross and hammersmith hospitals 2002
Questionnaire Audit of Surgical Doctors Charing Cross and Hammersmith Hospitals 2002
  • Aims - Assess prescription activities of surgical doctors for DVT prophylaxis
  • Questionnaire - 24 questions
  • Response rate - 100% (n=55)

Howard et al EVF 2003

doctors
Doctors

Howard et al EVF 2003

doctors prescribing prophylaxis
Doctors Prescribing Prophylaxis

Howard et al EVF 2003

source of information
Source of Information

Howard et al EVF 2003

thromboembolic risk assessment
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

education and awareness programme cxh 2002
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
audit of cxh protocol urology git vascular and breast surgery
AUDIT OF CXH PROTOCOL Urology, GIT, Vascular and Breast Surgery

(n=45)

(n=34)

(p=0.1)

(p=0.03)

(p=0.003)

2006 audit of compliance with hospital single protocol
2006 Audit of Compliance With Hospital Single Protocol

Only 60 patients = 19% [95% CI 14-23%]

n = 324

failure of prophylaxis application
Failure of Prophylaxis Application

233 patients

Failed to receive GCS

(72%)

151 patients

Failed to receive LMWH

(47%)

lessons learnt
Lessons Learnt!

Sporadic education and audit does not maintain compliance in VTE

Why?

Silent disease until its too late

Prevention is not exciting

slide16

How Can The

Situation

Be Improved?

effective strategy
Effective Strategy
  • Multifacted
  • Evidence-based protocols
  • Education
  • Risk assessment protocol
  • Computerised decision support
  • Audit with feedback
  • Specific staff for implementation
new programme 2008 colchester hospital university nhs foundation trust
New Programme 2008Colchester 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
education on risk is complex online risk assessment tool
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
education awareness programme
Education & Awareness Programme
  • E-learning assessment

(http://www.elearning-essexrivers.co.uk)

  • F1 and F2 teaching sessions
  • Nurse patient safety teaching sessions
  • Grand rounds
  • Clinical governance half-days
  • Electronic alerts in clinical areas
education awareness programme1
Education & Awareness Programme
  • E-learning assessment

(http://www.elearning-essexrivers.co.uk)

  • 70% pass mark
  • Certificate of completion
education awareness programme2
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)
audication in vte
‘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
audication in infection control
‘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
patient education
Patient Education
  • ‘Stop the Clot’ campaign
  • Patient information with hospital TCI letter
  • Focus Groups
  • Media help
maintaining practice
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
mr adam howard
Mr Adam Howard

Dept of Vascular and Laparoscopic Surgery

[email protected]

Mobile 07507646586

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