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 Electronic prescribing systems as tools to improve patient care: a learning health systems approach to increase guideline concordant prescribing for venous thromboembolism prevention

2021 ◽  
Author(s):  
S. Gallier ◽  
A. Topham ◽  
P. Nightingale ◽  
M. Garrick ◽  
I. Woolhouse ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Systems Approach ◽  
Electronic Prescribing ◽  
Low Molecular Weight ◽  
Vte Prophylaxis ◽  
Face To Face ◽  
Guideline Compliance ◽  
Hospitalised Patients

AbstractBACKGROUNDVenous thromboembolism (VTE) causes significant mortality and morbidity in hospitalised patients. In England, reporting the percentage of patients with a completed VTE risk assessment is mandated, but this does not include whether that risk assessment resulted in appropriate prescribing. Full guideline compliance (an assessment and action) is rarely reported. Education, audit and feedback enhance guideline compliance but electronic prescribing systems(EPS) can mandate guideline-compliant actions. We hypothesised that EPS-based interventions would increase full VTE guideline compliance more than other interventions.METHODSAll admitted patients within University Hospitals Birmingham NHS Foundation Trust were included for analysis between 2011-2020. The proportion of patients who received a fully compliant risk assessment and action was assessed over time. Interventions included face-to-face feedback based on measured performance (an individual approach) and mandatory risk assessment and prescribing rules into an EPS (a systems approach).RESULTSData from all 235,005 admissions and all 5503 prescribers were included in the analysis. Face-to-face feedback improved full VTE guideline concordance from 70% to 77% (p=<0.001). Changes to the EPS to mandate assessment with prescribing rules increased full VTE compliance to 95% (p=<0.001). Further amendments to the EPS system to reduce erroneous VTE assessments slightly reduced full compliance to 92% (p<0.001), but this was then maintained including during changes to the low molecular weight heparin used for VTE prophylaxis.DISCUSSION/ CONCLUSIONAn EPS-systems approach was more effective in improving sustained guideline-compliant VTE prevention. Non-compliance was still not eradicated despite this mandated system and requires further research.FUNDINGHDR-UK Hub PIONEERSummary BoxWhat is already known?Hospitalised patients are at an increased risk of venous thromboembolism (VTE), which can lead to significant morbidity and mortality. Risk factors for VTE are well known, there are established screening criteria and there is an effective prophylactic therapy, using low molecular weight heparin where indicated. Since 2010, NHS England has mandated the reporting of the percentage of patients with a completed VTE risk assessment. However, it does not automatically follow that completing a risk assessment leads to the appropriate action (prescribing and administering VTE prophylaxis where indicated). Currently it is unclear what percentage of patients have a guideline compliant VTE risk assessment and an associated action, or how full guideline compliance can be improved.What does this paper add?First, this paper describes that a VTE risk assessment does not always lead to full VTE guideline compliance (an appropriate prescription and administration of heparin where indicated). This is currently not part of mandated reporting but potentially could lead to patient harm. Second, that Electronic Health Systems (EHS) can capture and interrogate guideline-associated risk assessments and prescribing, and be used to improve full guideline compliance, through a combination of individual feedback to prescribing outliers and mandated prescribing rules. These EPS-assisted systems are robust, and sustain guideline compliance through personnel and formulary changes.

VTE Prevention in a District General Hospital

2011 ◽  
Vol 93 (6) ◽  
pp. 196-197
Author(s):  
Matthew Worrall
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
General Hospital ◽  
District General Hospital ◽  
Hospital Deaths

It is now well over 20 years since the evidence of excess hospital deaths due to venous thromboembolism (VTE) was fully established. The steps to prevention through prophylaxis are relatively simple but it remains frustratingly out of reach for hospitals to apply them with consistency. The Bulletin visited Salisbury NHS Foundation Trust, which has managed dramatically to improve through standardisation and audit of VTE risk assessment.

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.

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.

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.

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