VTE prevention and anticoagulation practice

Mr A McSorley Lead Thrombosis Nurse RCHT

-Risk assessment and VTE avoidance

-RCA of hospital acquired VTE (HAT)

-Thrombosis & anticoagulation guidance

VTE is a major public health issue & results in approx.60,000 deaths per year in UK

VTE causes more deaths than breast cancer, RTAs and AIDS combined and 5 times the number of deaths from HAI’s (MRSA / C.Diff)

The total cost (direct & indirect)of managing a VTE is £640 million

1 in 3 people with a DVT(Deep Venous Thrombosis) will develop post-thromboticsymptoms within 3 years & 25% will develop a VLU later in life

25,000 die from a hospitalacquired VTE every year1

4 out of 5 DVTs areundetected as their symptoms mimic other conditions

Your Responsibility (c/f AC policy)5.6. Role of Individual Staff Members All Staff are responsible for: • Taking positive steps to ensure the appropriate

patient VTE assessment is completed accurately. • Ensuring any actions identified through monitoring

and evaluations are undertaken. • Ensuring that any incidents linked with VTE

assessment, prophylaxis or management are reported using the Trust’s incident reporting procedure

Avoiding hospital related Venous thrombo-embolism (VTE):

target >95% recorded initial risk assessmentwith monthly submission % to the DoH

CQUIN so RCHT received 2012-13 ~£0.3M

2013-4 RCA of hospital acquired VTE £0.11M

Assessment on admission (1) and at 24 hrs (2)Thrombosis prevention and anticoagulation policy (June 2011)

Assessment on admission and at 24 hrs (2)Thrombosis prevention and anticoagulation policy (June 2011)

Monthly pharmacy audit

Overall monthly results - target 95%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

% with initial assessment done

% with appropriate Rx

Linear (% with initial assessment done)

Linear (% with appropriate Rx)

VTE risk assessment on EPMA• You Tube video demonstration• ‘real time’ reporting of mis-match between

VTE risk assessment and actual prescription

• Planned report feed to ward for handovers• No longer use EPMA forms from 24th March

unless for fluids/infusions

Thrombosis Practitioner/facilitatorSupport the Risk assessment

processHAT RCA

-from July 2013 as part of CQUIN

-reports to Divisions (via DQLG)

DoH quality standards patient information

Peri-operative anticoagulation Anticoagulation related bleeding

RCA to dateQ2 = 90 RCA, preventable HAT = 13Q3 = 112 RCA, preventable HAT = 11Q4 = 12 to date

Emerging themes/causes of HAT•Failure to prescribe AES for patients

not suitable or unwilling for LMWH•Failure to initiate LMWH or omission of

doses – EPMA issue??•Failure to provide AES when LMWH

stopped for intervention

Prescribing AES in EPMA

•Nurses can prescribe AES under group protocol•Available under POE on EPMA•Select ‘patient’ then search for ‘ANTIE’ (NOT TEDS)•Will populate with a STAT and ongoing dose automatically

Clinical Guideline For Thrombosis PreventionInvestigation And Management Of Anticoagulation

Venous thrombo-embolism–Risk assessment

Therapeutic anticoagulation–investigation, therapy and

duration–cancer

Complications–bleeding

Special circumstances–Surgery–Thrombophilia investigation–Pregnancy