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What still needs to be achieved in the clinical situation?. VTE Symposium – sharing good practice 21 st September 2010. Dr Tamara Everington. What is your background?. Doctor Nurse Pharmacist Risk Manager Executive Other. NICE Quality Standard 1.

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What still needs to be achieved in the clinical situation

What still needs to be achieved in the clinical situation?

VTE Symposium – sharing good practice

21st September 2010

Dr Tamara Everington


What is your background
What is your background?

  • Doctor

  • Nurse

  • Pharmacist

  • Risk Manager

  • Executive

  • Other


Nice quality standard 1
NICE Quality Standard 1

  • “All patients, on admission, receive an assessment of VTE and bleeding risk”



Which 1 of these do you think is most likely to increase compliance with vte risk assessment
Which 1 of these do you think is most likely to increase compliance with VTE risk assessment?

  • CQUINS targets

  • Executive Drivers

  • Better staff education

  • Electronic Systems

  • Productive Wards


Nice quality standard 2
NICE Quality Standard 2 compliance with VTE risk assessment?

  • “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
How should you document repeat VTE RA at 24 hours? compliance with VTE risk assessment?

  • Repeat the initial VTE RA document

  • Document in the clinical pathway (PTWR)

  • Pharmacy check

  • Nurse check

  • Other


Nice quality standard 3
NICE Quality Standard 3 compliance with VTE risk assessment?

  • “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
Which groups would you adjust thromboprophylaxis dose in? compliance with VTE risk assessment?

  • Renal impairment

  • Obesity

  • Cancer patients with cachexia

  • Recurrent “fallers”

  • All of the above

  • None of the above


Which day cases do you plan to risk assess
Which day cases do you plan to risk assess? compliance with VTE risk assessment?

  • Day surgery under GA

  • Day surgery under LA

  • Fracture clinic

  • Chemotherapy patients

  • Medical day cases

  • 1,(2), 3 & 4

  • All of the above


In theory we could reduce secondary vte by 65
In theory we could reduce secondary VTE by 65%? compliance with VTE risk assessment?


How will you pick up secondary vte
How will you pick up secondary VTE? compliance with VTE risk assessment?

  • Via anticoagulant referrals

  • Via radiology reports of VTE

  • Via clinical coding

  • Via death certificates

  • Via the Coroner

  • Combination of the above?


Nice quality standards 4 5
NICE Quality Standards 4 & 5 compliance with VTE risk assessment?

  • “Patients / carers are offered verbal and written information on VTE prevention at time of admission…. & as part of the discharge process”


Simples!!!! compliance with VTE risk assessment?

If only!!!


What information is most likely to work
What information is most likely to work? compliance with VTE risk assessment?

  • Written information

  • Visual information

  • Face-to-face explanation

  • A mixture of the above


Nice quality standard 6
NICE Quality Standard 6 compliance with VTE risk assessment?

  • “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
Which of the following have you seen on patients? compliance with VTE risk assessment?

  • Which of the following have you seen on patients?

  • Stockings causing a ‘tourniquet’ effect

  • Damaged legs from stockings

  • Soiled stockings

  • All of the above

  • “I wish you hadn’t asked that question”


Nice quality standard 7
NICE Quality Standard 7 compliance with VTE risk assessment?

  • “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.

  • Not at all

  • Aspirin only

  • For 28 days following surgery

  • Indefinitely

How long would you continue thromboprophylaxis?


Root cause analysis how do we do this
Root cause analysis – How do we do this? ovarian cancer with reduced mobility which can be controlled with indefinite chemotherapy.


Which method of rca do you think will be most effective
Which method of RCA do you think will be most effective? ovarian cancer with reduced mobility which can be controlled with indefinite chemotherapy.

  • RCA by the Thrombosis Committee

  • RCA by the VTE nurse

  • RCA by Clinical risk

  • RCA by Clinical teams


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