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Working together to achieve nursing excellence in VTE. Katrina Glaister Clinical Governance Facilitator (VTE Project Nurse) Salisbury NHS Foundation Trust. VTE prophylaxis in Salisbury. Who are we? Where we were Where we are now Top tips!. Salisbury NHS Foundation Trust.

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working together to achieve nursing excellence in vte

Working together to achieve nursing excellence in VTE

Katrina Glaister

Clinical Governance Facilitator (VTE Project Nurse)

Salisbury NHS Foundation Trust

vte prophylaxis in salisbury
VTE prophylaxis in Salisbury
  • Who are we?
  • Where we were
  • Where we are now
  • Top tips!
salisbury nhs foundation trust
Salisbury NHS Foundation Trust
  • 500 beds. 200, 000 people locally
  • Specialist services to 3 million people
  • Spinal Unit services to 11 million people.
where we were
Where we were …..
  • July 2007
  • Policy
  • VTE Working Group
  • Aim: to develop a simple (evidence based) tool to assess VTE risk, implement and measure progress (improvement)
where we are now
Where we are now…..
  • Demonstrated sustained improvement - Exemplar site
  • VTE nurse (part time)
  • VTE policy – Trust-wide
  • Risk assessment + patient self-assessment
  • Audit +++
  • Education, education, education
  • Patient information
  • Thrombosis Committee
vte risk assessment
VTE Risk Assessment
  • Local practice
  • Aim - one tool
  • Orthopaedics, palliative care, plastics, haematology & urology
  • Orthopaedics (oral prophylaxis)
risk assessment documentation
Risk Assessment – documentation
  • Wanted it simple!
  • Audit

Who assesses in Salisbury?

  • Surgery – nurses
  • Medicine – doctors
  • Either way, nurses are key
vte prophylaxis
VTE prophylaxis
  • Low risk = advice only
  • High risk = fixed dose low molecular weight heparin (LMWH) unless contraindicated (if so then GCS if OK)
  • If high risk + history of previous VTE - LMWH plus GCS

Can patients self-assess?

Outpatients in: Fracture clinic, Day Surgery, Oncology

  • Pharmacists central to our success
  • Trust-wide audit
  • Reporting:
    • Celebrated good practice
    • League tables
    • Clinical Governance newsletters
    • Published article
education raising awareness
Education & raising awareness
  • Staff
    • 1:1, ward-based, awareness days, symposium, Clinical Governance Sessions, screen saver, Hospital Rounds, Junior Doctors, Physiotherapists, M&M meetings, feedback from incidents, RCA for all secondary VTE events ….
  • Patient stories
  • Patients are key!
    • Governor on Thrombosis Committee, DVD, written information, plasma screens, Patientline/Hospedia, Foundation Constituency meetings, Annual Review article, Health Fairs, AGM …….
    • Message is :
      • Get out of bed ASAP
      • Exercise if on bed-rest
      • Take deep breaths
      • Stay hydrated.
an informed public
An informed public?
  • Terminology – the general public vaguely understand what DVT is, but not VTE
  • From a member of public at a Wiltshire Health Fair “VTE is the thing you get on a plane or when you have an operation and three weeks later you die”
an informed public14
An informed public?
  • I've heard of a DVT – what is a VTE?
  • Is VTE the new buzz word?
  • Is VTE a breakfast cereal? - I've heard of DVT - a pain in the leg!'
  • I still call it DVT - never heard of VTE
  • Never heard of VTE - is it when you have thick blood?
  • They changed it did they? I knew DVT!
  • I've had 3 DVTs - I wouldn't know VTE - I had sticky blood as part of Lupus
educating patients
Educating patients
  • Written patient information:
    • Average reading age in UK is around 11 years
    • Health literacy is recognised as a problem in UK and elsewhere
    • Coming into hospital patients are given many information sheets – do they read them?
    • “Oh yes, I did get one of those, I sent it home with the wife, she’s much more interested in that sort of thing than me”






1= Policy approved, 2= Policy launched, 3= Audit data presented to wards as league tables, 4= Intensive education & link nurse programme,5= Executive drivers & pharmacy mandate (no RA = no drugs)


Deaths with VTE at Salisbury

2007- 2009





number of deaths

with VTE



from VTE




Oct 07 -

Apr 08 -

Oct 08 -

Apr 09-

Mar 08

Sep 08

Mar 09

Sep 09

top tips
Top tips
  • Patient stories are a powerful learning tool/motivator
  • Regular early reinforcement about VTE ‘at the coal face’ ensures that risk assessment is embedded
  • Build ‘change’ into normal practice
  • Audit – essential and time consuming – IT helps!
  • Semi-competitive ‘league tables’ increase compliance
  • Provide VTE outcome data directly to staff
  • Executive endorsement ensures that work progresses
  • Work in progress, there is more to do!