scholarly journals EP.FRI.495 A retrospective audit of electronic venous thromboembolism risk assessment compliance across three surgical wards in a district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Tavlene Banwaith ◽  
Mohammed Kaif Qayum ◽  
Chokkalingam Arun ◽  
Ghulam Nawaz
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Tool ◽  
District General Hospital ◽  
Risk Assessments ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Retrospective Audit ◽  
The Mean ◽  
Audit Cycle

Abstract Aims Venous thromboembolism (VTE) is the leading cause of preventable hospital deaths; with hospital-acquired VTEs accounting for 50% to 60% of all VTEs seen. This project aims to review and improve the number of VTE risk assessments completed for surgical in-patients. Methods This retrospective, cross-sectional study involved data collection from surgical in-patients (n = 648) over three consecutive months, using an electronic VTE risk assessment tool. Data was categorised into ‘First VTE prophylaxis risk assessment completed within 24 hours of admission’ and ‘Second VTE prophylaxis risk assessment completed within 48 hours of admission’. This was further sub-categorised into surgical specialties. Results were presented in departmental meetings and educational posters were displayed. The study was re-audited using the same method over one month (n = 216). Results Results demonstrated improvement from the initial audit cycle, particularly in relation to the mean number of VTE risk assessments completed for patients undergoing breast surgery (100% from 95.3%), colorectal surgery (93.3% from 90%) and general surgery (88.0% from 86.6%). The mean number of first VTE risk assessments completed in 24 hours across all surgical wards remained above 65%, whilst the mean number of second VTE risk assessments completed in 48 hours improved from 36.1% to 47.6%. Conclusions Variation in compliance is still evident across the surgical in-patient wards. Going forward, responsibility to complete outstanding VTE risk assessments will be handed to the FY1 on the late shift. Following this intervention, a further audit cycle will be performed, with the aim of 100% compliance in VTE risk assessment completion.

scholarly journals Venous thromboembolism risk in psychiatric in-patients: a multicentre cross-sectional study

2019 ◽  
Vol 43 (6) ◽  
pp. 255-259
Author(s):  
Natalie Ellis ◽  
Carla-Marie Grubb ◽  
Sophie Mustoe ◽  
Eleanor Watkins ◽  
David Codling ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
The Uk

Aims and methodWe assessed venous thromboembolism (VTE) risk, barriers to prescribing VTE prophylaxis and completion of VTE risk assessment in psychiatric in-patients. This was a cross-sectional study conducted across three centres. We used the UK Department of Health VTE risk assessment tool which had been adapted for psychiatric patients.ResultsOf the 470 patients assessed, 144 (30.6%) were at increased risk of VTE. Patients on old age wards were more likely to be at increased risk than those on general adult wards (odds ratio = 2.26, 95% CI 1.51–3.37). Of those at higher risk of VTE, auditors recorded concerns about prescribing prophylaxis in 70 patients (14.9%). Only 20 (4.3%) patients had a completed risk assessment.Clinical implicationsMental health in-patients are likely to be at increased risk of VTE. VTE risk assessment is not currently embedded in psychiatric in-patient care. There is a need for guidance specific to this population.

scholarly journals Successful Model for Guideline Implementation to Prevent Cancer-Associated Thrombosis: Venous Thromboembolism Prevention in the Ambulatory Cancer Clinic

2020 ◽  
Vol 16 (9) ◽  
pp. e868-e874 ◽  
Author(s):  
Chris E. Holmes ◽  
Steven Ades ◽  
Susan Gilchrist ◽  
Daniel Douce ◽  
Karen Libby ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Assessment Tool ◽  
Guideline Implementation ◽  
Vte Prophylaxis ◽  
Successful Model ◽  
Venous Thromboembolism Prevention ◽  
Risk Patients ◽  
Cancer Associated Thrombosis

PURPOSE: Guidelines recommend venous thromboembolism (VTE) risk assessment in outpatients with cancer and pharmacologic thromboprophylaxis in selected patients at high risk for VTE. Although validated risk stratification tools are available, < 10% of oncologists use a risk assessment tool, and rates of VTE prophylaxis in high-risk patients are low in practice. We hypothesized that implementation of a systems-based program that uses the electronic health record (EHR) and offers personalized VTE prophylaxis recommendations would increase VTE risk assessment rates in patients initiating outpatient chemotherapy. PATIENTS AND METHODS: Venous Thromboembolism Prevention in the Ambulatory Cancer Clinic (VTEPACC) was a multidisciplinary program implemented by nurses, oncologists, pharmacists, hematologists, advanced practice providers, and quality partners. We prospectively identified high-risk patients using the Khorana and Protecht scores (≥ 3 points) via an EHR-based risk assessment tool. Patients with a predicted high risk of VTE during treatment were offered a hematology consultation to consider VTE prophylaxis. Results of the consultation were communicated to the treating oncologist, and clinical outcomes were tracked. RESULTS: A total of 918 outpatients with cancer initiating cancer-directed therapy were evaluated. VTE monthly education rates increased from < 5% before VTEPACC to 81.6% (standard deviation [SD], 11.9; range, 63.6%-97.7%) during the implementation phase and 94.7% (SD, 4.9; range, 82.1%-100%) for the full 2-year postimplementation phase. In the postimplementation phase, 213 patients (23.2%) were identified as being at high risk for developing a VTE. Referrals to hematology were offered to 151 patients (71%), with 141 patients (93%) being assessed and 93.8% receiving VTE prophylaxis. CONCLUSION: VTEPACC is a successful model for guideline implementation to provide VTE risk assessment and prophylaxis to prevent cancer-associated thrombosis in outpatients. Methods applied can readily translate into practice and overcome the current implementation gaps between guidelines and clinical practice.

Venous thromboembolism in psychogeriatric in-patients – A study of risk assessment, incidence, and current prophylaxis prescribing

2013 ◽  
Vol 25 (6) ◽  
pp. 913-917 ◽  
Author(s):  
Xinsheng Liu ◽  
Fintan O'Rourke ◽  
Huong Van Nguyen
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Scoring System ◽  
Risk Group ◽  
Low Risk ◽  
Vte Prophylaxis ◽  
Retrospective Audit ◽  
Medium Risk ◽  
Risk Scoring ◽  
Risk Scoring System

ABSTRACTBackground: While venous thromboembolism (VTE) risk assessment and prophylaxis is well established for medical and surgical in-patients, there is a paucity of evidence, and therefore guidelines, in this area for psychogeriatric in-patients. We wished to determine VTE incidence, risk, and use of prophylaxis, in a psychogeriatric in-patient population.Methods: Retrospective audit of consecutive psychogeriatric patients aged 65 years and over admitted to Bankstown Hospital over a 3-year period, 2007–2009. Using an adapted VTE risk scoring system, patients were assigned as low, medium, or high VTE risk.Results: A total of 192 patients were included in the study. Mean age was 79.1 ± 7.0 years. Out of the total, 55.2% of patients had diagnosis of dementia, and 33.3% had depression. Overall, 81.8% (157/192) were assessed as low risk, and 18.2% (35/192) as medium risk. Also, 16.7% (32/192) received VTE prophylaxis.Four new VTE events occurred in medium-risk group, and one in low-risk group (p = 0.004). Overall VTE incidence was 10.5/10,000 patient-days, but 44.2 per 10,000 in medium-risk group. VTE risk score was predictive of VTE events – IRR 6.02 (95% Confidence Intervals (CI) = 1.76–20.7, p = 0.004) for every one-point increment in risk. Depression was associated with significantly higher VTE occurrence (6.3% in those with diagnosis vs. 0.8% without, p = 0.043).Conclusion: Using a VTE risk scoring system adapted for psychogeriatric in-patients, those assessed to be at medium risk had a significantly increased rate of VTE. On this basis, we would recommend VTE prophylaxis be prescribed for psychogeriatric in-patients assessed to be at medium and high level of risk.

scholarly journals Multidisciplinary, patient-centred approach to improving compliance with venous thromboembolism (VTE) prophylaxis in a district general hospital

2020 ◽  
Vol 9 (3) ◽  
pp. e000680
Author(s):  
Melanie Nana ◽  
Cherry Shute ◽  
Rhys Williams ◽  
Flora Kokwaro ◽  
Kathleen Riddick ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Quality Improvement ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
General Hospital ◽  
District General Hospital ◽  
Educational Material ◽  
Standards Of Care ◽  
Vte Prophylaxis ◽  
Hospitalised Patients

Hospital-acquired venous thromboembolism (VTE) accounts for an estimated 25 000 preventable deaths per annum in the UK and is associated with significant healthcare costs. The National Institute for Health and Care Excellence guidelines on the prevention of VTE in hospitalised patients highlight the clinical and cost-effectiveness of VTE prevention strategies. A multidisciplinary quality improvement team (MD QIT) based in a district general hospital sought to improve compliance with VTE prophylaxis prescription to greater than 85% of patients within a 3-month time frame. Quality improvement methodology was adopted over three cycles of the project. Interventions included the introduction of a ‘VTE sticker’ to prompt risk assessment; educational material for medical staff and allied healthcare professionals; and patient information raising the awareness of the importance of VTE prophylaxis. Implementation of these measures resulted in significant and sustained improvements in rates of risk assessment within 24 hours of admission to hospital from 51% compliance to 94% compliance after cycle 2 of the project. Improvements were also observed in medication dose adjustment for the patient weight from 69% to 100% compliance. Dose adjustments for renal function showed similar trends with compliance with guidelines improving from 80% to 100%. These results were then replicated in a different clinical environment. In conclusion, this project exemplifies the benefits of MD QITs in terms of producing sustainable and replicable improvements in clinical practice and in relation to meeting approved standards of care for VTE risk assessment and prescription. It has been demonstrated that the use of educational material in combination with a standardised risk assessment tool, the ‘VTE sticker’, significantly improved clinical practice in the context of a general medical environment.

scholarly journals 37 Accuracy of Venous Thromboembolism Risk Assessments in The Trauma and Orthopaedics Wards of The Gloucestershire Royal Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Njim ◽  
A Hafez ◽  
I Omar
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Clinical Guideline ◽  
Risk Groups ◽  
Lower Limbs ◽  
Risk Assessments ◽  
Royal Hospital ◽  
Vte Prophylaxis ◽  
Inflammatory Conditions ◽  
Thrombosis Risk

Abstract Introduction Venous thromboembolism (VTE) risk assessment is crucial for patients undergoing orthopaedic surgery. An accurate risk assessment leads to patient stratification into risk groups for appropriate VTE prophylaxis. Aim To evaluate the accuracy of VTE risk assessment in the orthopaedic wards of the Gloucestershire Royal Hospital (GRH). Method We used the drug charts available on the wards of GRH which follow the NICE Clinical guideline [CG92]. We identified four variables out of the 19 questions that assess thrombosis risk: age, BMI, presence of infection/inflammatory conditions and surgery to the lower limb. Drug charts from the 10th of November to the 15th of November 2020 were assessed for completeness and accuracy. The number and accuracy of drug charts with VTE risk assessments on admission and 24 hours after admission were assessed. Results Fifty-seven drug charts with VTE risk assessments were identified over this period. Only 66.7% of VTE risk assessments were complete on admission and 21.1% were complete 24 hours after admission. Accuracy of assessment on admission was 92.1%, 86.1%, 81.6% and 79.0% for age, BMI, categories of surgery to the lower limbs and presence of inflammation, respectively. Accuracy of assessment at 24 hours was 91.7%, 83.3%, 50.0% and 91.7% for age, BMI, surgery to the lower limbs and presence of infection/inflammation, respectively. Conclusions VTE risk assessment upon admission and at 24 hours is relatively low and needs improvement. A further enquiry is necessary to evaluate the reasons for defective VTE assessment.

Assessing the risk of venous thromboembolism in psychiatric in-patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S686-S686
Author(s):  
N. Ellis ◽  
M. Quraishy ◽  
C.M. Grubb ◽  
S. Fitch ◽  
J. Harrison
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Health Board ◽  
Compression Stockings ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Competing Interest ◽  
The Uk

IntroductionVenous thromboembolism (VTE) is a potentially fatal condition. Hospital-associated VTE leads to more than 25,000 deaths per year in the UK. Therefore identification of at-risk patients is crucial. Psychiatric in-patients have unique factors which may affect their risk of VTE (antipsychotic prescription, restraint) however there are currently no UK guidelines which specifically address VTE risk in this population.ObjectivesWe assessed VTE risk among psychiatric inpatients in Cardiff and Vale university health board, Wales, UK, and whether proformas currently provided for VTE risk assessment were being completed.MethodsAll acute adult in-patient and old age psychiatric wards were assessed by a team of medical students and a junior doctor over three days. We used the UK department of health VTE risk assessment tool which was adapted to include factors specific for psychiatric patients. We also assessed if there were concerns about prescribing VTE prophylaxis (compression stockings or anticoagulants), because of a history of self-harm or ligature use.ResultsOf the 145 patients included, 0% had a completed VTE risk assessment form. We found 38.6% to be at an increased risk of VTE and there were concerns about prescribing VTE prophylaxis in 31% of patients.ConclusionsOur findings suggest that VTE risk assessment is not being carried out on psychiatric wards. Staff education is needed to improve awareness of VTE. Specific guidance for this population is needed due to the presence of unique risk factors in psychiatric in-patients and concerns regarding VTE prophylaxis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

An observational study for venous thromboembolism risk assessment among hospitalized patients in general surgery clinics across Turkey

2011 ◽  
Vol 26 (8) ◽  
pp. 344-352 ◽  
Author(s):  
Mehmet Kurtoglu
Keyword(s):  
Public Health ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
General Surgery ◽  
Public Health Problem ◽  
Hospitalized Patients ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Vte Prophylaxis ◽  
Clinical Awareness

Objective Venous thromboembolism (VTE) still remains a significant public health problem due to gaps between recommendations and clinical practice in VTE prophylaxis. This is the first clinical study designed to evaluate the applicability of a standard ‘VTE prophylaxis and risk factor assessment form (VTE-PRAF)’ and prescription of VTE prophylaxis among hospitalized patients in the daily practice of general surgeons in Turkey. Method A total of 1472 patients (mean age: 52.4 ± 16.9 years; 50.6% were men) were included in cross-sectional ( n = 537), first longitudinal ( n = 452) or the second longitudinal ( n = 483) phases. Data on demographics, hospitalization, surgical intervention and prophylaxis were collected during the cross-sectional phase, whereas utilization of form was evaluated during longitudinal phases. Results While 62.1% of patients were identified to be at ‘high+ highest’ risk, prophylaxis was evident only for 65.9%. Utilization of the form was higher in the second longitudinal phase ( P < 0.001) but there was no relation between implementation of the form and prophylaxis use. VTE-PRAF was completed for 70.6% and 84.8% of patient who received prophylaxis while it was completed for 50.8% and 50.4% of patients with no prophylaxis, in the first and second longitudinal phases, respectively. Prophylaxis was administered in 58.6% and 62.6% of patients with completed VTE-PRAF in the first and second longitudinal phases, respectively. ‘Suggested’ and ‘used’ prophylaxis regimens were significantly more consistent for the cases evaluated with VTE-PRAF ( P < 0.001). Conclusion Based on the use of prophylaxis only for 65.9% of general surgery inpatients at high risk for VTE, low use of prophylaxis is assumed to remain a significant threat to public health across Turkey. Inclusion of a standard VTE-PRAF in the hospital protocol seems to raise clinical awareness of VTE risk assessment and appropriate management in VTE which otherwise well-known to be associated with significant mortality and morbidity. Impact of e-VTE-PRAF is worth investigating.

scholarly journals A Snapshot of Venous Thromboembolism (VTE): Retrospective Audit of Events at a Metropolitan Tertiary Referral Hospital

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4264-4264
Author(s):  
Julianne Chong ◽  
Rukmal K Dissanayake ◽  
Sarah Younan ◽  
Michael V Chan ◽  
Yao Yang ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Conflicts Of Interest ◽  
Local Level ◽  
Referral Hospital ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Vte Prophylaxis ◽  
Retrospective Audit ◽  
Significant Difference

Abstract Background Facility-level review of hospital-acquired venous thromboembolism (HA-VTE) cases, including pulmonary embolism (PE) and deep vein thrombosis (DVT), can provide insight into the local drivers of this preventable complication. Aim To determine the nature of HA-VTE, patient characteristics, VTE risk assessment completion and appropriateness of prescribed VTE prophylaxis at a metropolitan tertiary referral hospital and to compare the number of HA-VTE detected by audit of imaging scans with those reported by clinical coding. Methods We conducted a retrospective electronic medical record audit encompassing all patients diagnosed with HA-VTE via ventilation-perfusion scan, computed tomographic pulmonary angiography and/or doppler ultrasound using a demographic and VTE risk assessment audit tool during selected months of 2017-2019. We compared the number of manually audited cases with the number of performance unit-coded cases for the same months. Results The months of May 2017, October 2017, April to July 2018 and April to July 2019 were included. There was a significant difference between HA-VTE detected via manual audit (147 events) and hospital coding (18 events), p=0.002. Manual audit patients were majority non-surgical (65%), female (58%), over 60 years (80%), at moderate VTE risk (71%) with reduced mobility (52%). There were 108 DVT-only (73%), 23 PE-only (16%) and 16 DVT plus PE events (11%). Notable risk factors were moderate to major surgery (30%), active malignancy or cancer treatment (24%) and active infection (27%). Most patients were prescribed appropriate VTE prophylaxis (74%) and had documented VTE risk assessment (68%). Appropriate VTE prophylaxis was significantly associated with using an electronic clinical decision support tool during VTE risk assessment (p=0.024). Conclusion Facility-driven HA-VTE audits provide opportunity to developed targeted initiatives for at-risk patients at a local level. Greater numbers of HA-VTE identified via manual audit suggest the need for future real-time documentation of HA-VTE to assist with efficient case review. Disclosures No relevant conflicts of interest to declare.

scholarly journals Risk Asessment and Thromboprophylaxis for Venous Thromboembolism (VTE) in the Antenatal Population in a Tertiary Health Facility in Nigeria

2021 ◽  
pp. 134-142
Author(s):  
Mkpe Abbey ◽  
Green Kinikanwo
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Health Facility ◽  
First Trimester ◽  
Routine Practice ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Port Harcourt ◽  
Study Population

Aim: To review the venous thromboembolism (VTE) risk assessment and thromboprophylaxis in the antenatal population in a tertiary health facility in Nigeria and to perform a retrospective VTE risk assessment of the patients with a view of determining those patients that would have needed VTE prophylaxis. Design: It was a retrospective cross-sectional study. Place and Duration of Study: The study was carried out at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria from the 1st of February to the 30th of April, 2020. Materials and Methods: The following data were extracted from the hospital notes of 347 consecutive antenatal patients: history/demographic characteristics, risk factors for VTE, thromboprophylaxis, diagnosis and treatment of VTE, using the RCOG guideline 37a of 2015 as a benchmark for comparison. Data was analysed with the aid of a Statistical Package for Social Science (SPSS) software, version 18. Results: VTE risk assessment and thromboprophylaxis  was not a routine practice at the UPTH. Apart from antenatal admission, the most frequent VTE risk factors in pregnancy were  BMI ≥30, Parity ≥ 3, Age > 5 years and current pre-eclampsia at 48.48%, 41.04%, 36.04% and 15.56% of the study population respectively. 131 (37.75%) of the 347 antenatal population fulfilled the criteria for venous thromboprophylaxis with low molecular weight heparin (LMWH) but they were not assessed and the drug was not given. 63 (18.16%) of the study population was to receive LMWH from 28 weeks of pregnancy while 68 (19.60%) of them were to be given from the first trimester. The prevalence of VTE was however very low at 0.02% (1 patient out of the 347 maternities), irrespective of the fact that 41 (11.82%) of the patients had symptoms and signs of VTE. Conclusion: 131 (37.75%) out of the total 347 antenatal patients fulfilled the criteria to be given thromboprophylaxis but the prevalence of VTE was low at 0.02%. It was therefore recommended that a unified Nigerian national guideline should be written.

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