What still needs to be achieved in the clinical situation
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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?

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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”


How do we crack the last 10

How do we crack the last 10%?


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

  • “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?

  • 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

  • “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?

  • 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?

  • 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%?


How will you pick up secondary vte

How will you pick up secondary VTE?

  • 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

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


What still needs to be achieved in the clinical situation

Simples!!!!

If only!!!


What information is most likely to work

What information is most likely to work?

  • Written information

  • Visual information

  • Face-to-face explanation

  • A mixture of the above


Nice quality standard 6

NICE Quality Standard 6

  • “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?

  • 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

  • “Patients receive extended postoperative VTE prophylaxis in accordance with NICE guidance”


What still needs to be achieved in the clinical situation

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?


Which method of rca do you think will be most effective

Which method of RCA do you think will be most effective?

  • RCA by the Thrombosis Committee

  • RCA by the VTE nurse

  • RCA by Clinical risk

  • RCA by Clinical teams


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