Improving Patient Safety and Achieving CQUIN Target Whipps Cross University Hospital, London. ABSTRACT
Whipps Cross University Hospital, London
Venous thromboembolism (VTE) is the leading cause of maternal morbidity and mortality within the UK. Identifying the key risk factors and their relative severity is crucial to pertinent management strategies. Assessment of these risk factors can be exhaustive, and lack of standardised access to this dataset can prohibit early intervention and disease prevention.
To reduce maternal deaths, the Commissioning for Quality and Innovation Framework (CQUIN) set in place by the National Institute for Health and Clinical Excellence (NICE), recently recommended that the NHS in England introduce a national risk assessment tool to reduce maternal deaths.
The aim of this study was to identify and assess the risk of pregnant women developing VTE in a busy obstetric department that delivers 6000 babies per year, and to evaluate whether a VTE risk assessment proforma was accurately completed in accordance with hospital and RCOG guidelines.
The importance of the proforma was thought to be recognised given the high completion rate in the antenatal group, particularly after the re-audit period. More work is needed to ensure that healthcare staff are able to identify risk factors correctly and accurately. Furthermore, weight recordings for the patient group was poor, which may potentially lead to inaccurate management plans if not corrected in the future.
50 patients were randomly identified who were either antenatal or postnatal. 85% of proformas were found to be completed for the antenatal group compared with the 63% completed for the postnatal. We found that 60% of patients in both groups were identified as having the correct risk factors being recorded on our proformas. 6% of patients did not have any risks assessed. Weight recording for drug dosage calculation was recorded for 44% of the patients. After the 6 month interval, the re-audit showed that 99% of the proformas were completed for antenatal women, which contributed to successfully achieving overall CQUIN hospital trust target of 90%.
A standardised proforma using RAG (red, amber green) rating was created to assess all women who were booked for their pregnancy under our care. Retrospectively over a four month period, we identified a sample cohort of patients who were assumed to be assessed with these proformas. Completion of the proformas were then analysed to ensure correct identification of risk factors and correlation between suggested and initiated management plans. Following this, the proformas were re-audited 6 months later.
Naila Khan ([email protected])
H Ranaweera, Z Ahmed, S Thamban