scholarly journals 1087 Establishing Guidelines for VTE Prophylaxis for Acute ENT Admissions

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Wallace ◽  
K Hepburn ◽  
J O'Hanlon ◽  
S Davis
Keyword(s):  
Risk Assessment ◽  
Patient Safety ◽  
Patient Group ◽  
Active Bleeding ◽  
Vte Prophylaxis ◽  
Low Incidence ◽  
Pharmacological Thromboprophylaxis ◽  
Acute Admissions

Abstract Aim VTE prophylaxis is a vital aspect of patient safety. The decision whether to offer pharmacological thromboprophylaxis is a balance of risk versus benefit. There is a low incidence of VTE in ENT patients, admissions are often short and active bleeding on admission is not uncommon (epistaxis patients, already on anticoagulation are particularly difficult to manage}. There are no clear, specialty specific guidelines to assist in these frequently encountered endeavours. Method The number of emergency ENT admissions who had a documented VTE during admission or in the 28 days following was used to calculate the incidence of VTE in acute admissions. An audit of VTE prophylaxis and documentation was also conducted using 20 admissions over 24 hours. Results Incidence was 0.12%. 75% had a documented VTE risk assessment. Only 50% patients were prescribed chemical and mechanical thromboprophylaxis. 0% had appropriately documented that the patient did not require thromboprophylaxis on the drug chart (as per trust guidelines). Conclusions The results showed that both documentation and prescribing related to VTE prevention were poor. By highlighting the low incidence amongst this patient group, we were able to establish clearer guidance for VTE prophylaxis in acute ENT admissions and a protocol to standardise the management of anticoagulation in actively bleeding epistaxis patients.

scholarly journals Improving venous thromboembolism prophylaxis through critical thinking and health informatics

2020 ◽  
Vol 9 (2) ◽  
pp. e000885 ◽  
Author(s):  
Haytham Taha ◽  
Ezhil Govindraj ◽  
Filestin Jaber ◽  
Ghadah Shehadeh ◽  
Bernadette Kelly ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Patient Safety ◽  
Quality Improvement ◽  
Critical Thinking ◽  
Venous Thromboembolism ◽  
Health Informatics ◽  
Adult Patients ◽  
Abu Dhabi ◽  
Improvement Project ◽  
Vte Prophylaxis

Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality in hospitalised patients. Mafraq Hospital, a 450-bed tertiary-level hospital in Abu Dhabi, United Arab Emirates, has identified VTE prevention as a critical patient safety measure and VTE prophylaxis as a key performance indicator (KPI). Mafraq Hospital VTE prevention policy states that all admitted adult patients 18 years and above should receive a VTE risk assessment, and all patients identified at risk of VTE with no contraindications should receive appropriate VTE prophylaxis within 24 hours of admission. In a move towards safer practices, our governing body, Abu Dhabi Health Services SEHA, has raised the VTE prophylaxis KPI target from 85% to 95% for all admitted adult patients within 24 hours of admission. Our average VTE prophylaxis rate was 87%, and achieving this new target was a challenge. We conducted this study on Mafraq Hospital Medical and Surgical wards. The study period was 12 months, from July 2018 to June 2019, and a total of 5475 patients were evaluated. Our aim was to improve VTE prophylaxis rates in order to ensure patient safety and reduce preventable harm. We used Caprini Model electronic VTE risk assessment computerised decision support tool to help identify VTE risk. A multidisciplinary task force team was formed and led this quality improvement project. The purpose of this publication was to indicate the quality improvement interventions implemented to enhance compliance with VTE prophylaxis using integrated critical thinking and health informatics and the outcomes of those interventions. Through implementing critical thinking and health informatics interventions, our VTE prophylaxis within 24 hours of admission rates improved from an average 87% in July 2018 to above 98%, and this improvement was sustained over the last 3 months of the study period April through June 2019.

Acute mastoiditis and intracranial complications in children

2021 ◽  
Vol 70 (4) ◽  
pp. 207-213
Author(s):  
Andrea Kaliariková ◽  
Klára Perceová ◽  
Jan Machač ◽  
Michal Jurajda ◽  
Milan Urík
Keyword(s):  
Streptococcus Pneumoniae ◽  
Patient Group ◽  
Clinical Manifestations ◽  
Aetiological Agent ◽  
Acute Mastoiditis ◽  
Average Value ◽  
Tertiary Centre ◽  
Number Of Patients ◽  
Intracranial Complications ◽  
Low Incidence

Objectives: Characterisation of clinical manifestations in children who had acute mastoiditis (AM) -related intracranial complications (ICCs) and to determine the incidence of ICCs in the study group. To define children with a higher risk of ICCs and gain new information on aetiological microbial agents of AM. Methods: A retrospective analysis of 137 paediatric patients with AM treated at a tertiary centre using standard dia­gnostic and therapeutic protocol between 2002 and 2019. Results: Altogether 137 patients with AM were hospitalised at our centre between 2002 and 2019. During this time, the occurrence of ICC in children with AM was low (n = 3, incidence 2.19%). Due to the low number of patients with ICC with AM in our patient group, we were unable to define a specific group of patients with a higher risk of ICC development in AM. Despite this fact, the average value and median of CRP were considerably higher in patients with AM-associated ICCs. The most frequent aetiological agent was Streptococcus pneumoniae. Conclusions: The low incidence of ICC in patients with AM in our patient group might be caused by routinely performed paracentesis in developed acute otitis, rational antibio­tic therapy and the good availability of an ENT specialist in the Czech Republic. The most common aetiological agent of AM was Streptococcus pneumoniae. Keywords: Streptococcus pneumoniae – acute mastoiditis – intracranial complications – aetiological agent – antibio­tic therapy – antromastoidectomy

EP.FRI.771 National audit on VTE prophylaxis for lower limb injuries treated in a plaster cast

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Georgios Karagiannidis ◽  
Omar Toma
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Lower Limb ◽  
Plaster Cast ◽  
Junior Doctors ◽  
National Audit ◽  
Lower Limb Injuries ◽  
Nice Guidelines ◽  
Vte Prophylaxis ◽  
Limb Injuries

Abstract Aims Audit to assess Orthopaedic departments’ compliance with NICE guidelines on Venous thromboembolism (VTE) prophylaxis published in 2010, specifically looking at VTE practices for patients with lower limb injuries treated in a plaster cast. Methods A telephonic survey was carried out on junior doctors within orthopaedic departments of 66 hospitals across all regions of England. A questionnaire was completed regarding VTE risk assessment, prophylaxis and hospital guidelines etc. Data collected from August 2016 till February 2017. Results 83% (n = 55) of trusts routinely give VTE prophylaxis to these patients. 96% (n = 64) give Chemoprophylaxis of some sort. Formal VTE assessments are performed in 81% (n = 54) and 77% (n = 51) have a local VTE prophylaxis policy. Conclusions We conclude that Orthopaedic departments across England have increased compliance with NICE guidelines for VTE prophylaxis. However there is considerable variation in practice, especially in duration and chemoprophylaxis agent. We attribute this to the lack of specific NICE guidelines for this cohort of patients. We aim that this study can influence NICE to introduce added guidance that will standardise practice.

The Current State of Paediatric Orthopaedic Venous Thromboprophylaxis

2013 ◽  
Vol 95 (1) ◽  
pp. 1-4
Author(s):  
J Wright ◽  
S Randhawa ◽  
C Gooding ◽  
S Lowery ◽  
D Eastwood ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Adult Patient ◽  
Quality Indicators ◽  
Clinical Excellence ◽  
Morbidity And Mortality ◽  
Vte Prophylaxis ◽  
Current State ◽  
Paediatric Orthopaedic ◽  
Hospital Inpatients

Venous thromboembolism (VTE) is widely understood to be an important cause both of morbidity and mortality in hospital inpatients. This has led to the development of guidelines for the management of VTE prophylaxis in adults by the national institute for Health and Clinical Excellence. In acknowledgement of the importance of this issue, there are government incentives in the form of Commissioning for Quality and innovation payments that are dependent on the performance of hospital trusts in certain quality indicators, such as risk assessment for VTE in the adult patient.

scholarly journals Are Regulations Safe? Reflections From Developing a Digital Cancer Decision-Support Tool

2021 ◽  
pp. 353-363
Author(s):  
Ciarán D. McInerney ◽  
Beverly C. Scott ◽  
Owen A. Johnson
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Patient Safety ◽  
Medical Device ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Cancer Risk Assessment ◽  
The European Union ◽  
Standards And Regulations ◽  
Fit For Purpose

PURPOSE Informatics solutions to early diagnosis of cancer in primary care are increasingly prevalent, but it is not clear whether existing and planned standards and regulations sufficiently address patients' safety nor whether these standards are fit for purpose. We use a patient safety perspective to reflect on the development of a computerized cancer risk assessment tool embedded within a UK primary care electronic health record system. METHODS We developed a computerized version of the CAncer Prevention in ExetER studies risk assessment tool, in compliance with the European Union's Medical Device Regulations. The process of building this tool afforded an opportunity to reflect on clinical concerns and whether current regulations for medical devices are fit for purpose. We identified concerns for patient safety and developed nine practical recommendations to mitigate these concerns. RESULTS We noted that medical device regulations (1) were initially created for hardware devices rather than software, (2) offer one-shot approval rather than supporting iterative innovation and learning, (3) are biased toward loss-transfer approaches that attempt to manage the fallout of harm instead of mitigating hazards becoming harmful, and (4) are biased toward known hazards, despite unknown hazards being an expected consequence of health care as a complex adaptive system. Our nine recommendations focus on embedding less-reductionist and stronger system perspectives into regulations and standards. CONCLUSION Our intention is to share our experience to support research-led collaborative development of health informatics solutions in cancer. We argue that regulations in the European Union do not sufficiently address the complexity of healthcare information systems with consequences for patient safety. Future standards and regulations should continue to follow a system-based approach to risk, safety, and accident avoidance.

Venous thromboembolism (VTE) prophylaxis

2018 ◽  
pp. 121-126
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Surgical Patients ◽  
Related Factors ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Preventable Complication ◽  
Fatal Complications

Venous thromboembolism is a common but largely preventable complication following surgery. However, fatal complications can occur as a result of pulmonary embolism following deep vein thrombosis. A structured risk assessment should be performed preoperatively in all surgical patients and thromboprophylaxis measures should be tailored according to patient- and procedure-related factors. These measures include anticoagulation with low molecular weight heparin and the use of mechanical compression devices.

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