national vte audit day results
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www.saferhealthcarenow.ca
National VTE Audit Day RESULTS
Bill Geerts & Artemis Diamantouros Virginia Flintoft, Anne MacLaurin and Alex Titeu
CPSI Central Measurement Team May 2013
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National VTE Audit Day RESULTS
Bill Geerts & Artemis Diamantouros Virginia Flintoft, Anne MacLaurin and Alex Titeu
CPSI Central Measurement Team May 2013
www.saferhealthcarenow.ca
www.saferhealthcarenow.ca
1. Methodology
2. Audit participation
3. Appropriate thromboprophylaxis use
4. Types of thromboprophylaxis used
5. Reasons for not using appropriate thromboprophylaxis
6. Use of Preprinted order sets
7. Feedback and discussion
VTE Audit Day Results - Outline
6
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• National VTE Audit Day: April 10, 2013
• Audit Sample: – General Internal Medicine and General Surgery
• National webinar (Mar 26) - Call to Action
• Engagement of sites & registration
• Each site contacted by CMT: – Identification of audit sample – Creation of data collection forms
VTE Audit Day - Overview
7
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• Launch of National VTE Audit: April 10, 2013
• Data Collection: April 10 to 18 – Extension for data submission to April 30
• Error reports corrected and resubmitted by Central Measurement Team (CMT)
• Analyses conducted by CMT with data from Patient Safety Metrics (PS Metrics)
VTE Audit Day - Methodology
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1. Methodology
2. Audit participation
3. Appropriate thromboprophylaxis use
4. Types of thromboprophylaxis used
5. Reasons for not using appropriate thromboprophylaxis
6. Use of Preprinted order sets
7. Feedback and discussion
VTE Audit Day Results - Outline
9
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Overall Response Rate
10
Sites 118 Patients 4,667
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Responses by Province
11
Site
s
118 sites 4,667 patients
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Responses by Major Patient Group
12
64% N=4,628
31%
2%
Site
s
2%
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1. Methodology
2. Audit participation
3. Appropriate thromboprophylaxis use
4. Types of thromboprophylaxis used
5. Reasons for not using appropriate thromboprophylaxis
6. Use of Preprinted order sets
7. Feedback and discussion
VTE Audit Day Results - Outline
13
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Appropriate Thromboprophylaxis - Overall Rates
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81%
N=4,667 %
of p
atie
nts
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Appropriate Thromboprophylaxis - By Major Patient Group
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79% 84%
% of
pat
ient
s
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Appropriate Thromboprophylaxis - by Province
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100%
% of
pat
ient
s 65%
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Appropriate Thromboprophylaxis - by Province and Major Patient Group
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% of
pat
ient
s
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Appropriate Thromboprophylaxis - by Province and Region
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Regions Reporting
National Average = 81%
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1. Methodology
2. Audit participation
3. Appropriate thromboprophylaxis use
4. Types of thromboprophylaxis used
5. Reasons for not using appropriate thromboprophylaxis
6. Use of Preprinted order sets
7. Feedback and discussion
VTE Audit Day Results - Outline
19
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Type of Thromboprophylaxis - Overall
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• LMWH = dalteparin, enoxaparin, fondaparinux, nadroparin, tinzaparin • Other = apixaban, dabigatran, rivaroxaban, warfarin (only 6%)
N=4,581 (3,619 on TPX)
LMWH + LDH = 90% LMWH = 61%
(4%)
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Type of Thromboprophylaxis – by Major Patient Group
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Patient group
Patients on TPX
LMWH LDH Mech Only
Gen Med 2225 69.5% 20.8% 4.6%
Gen Surg 1211 45.3% 45.6% 3.3%
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Type of Thromboprophylaxis - by Province
22
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Type of Thromboprophylaxis - by Province and Major Patient Group
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Type of Thromboprophylaxis - by Province and Region
24
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1. Methodology
2. Audit participation
3. Appropriate thromboprophylaxis use
4. Types of thromboprophylaxis used
5. Reasons for not using appropriate thromboprophylaxis
6. Use of Preprinted order sets
7. Feedback and discussion
VTE Audit Day Results - Outline
25
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Reasons for not using Thromboprophylaxis - Overall
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(72.2%)
(8.7%)
(8.1%)
(6.3%)
N=767
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Reasons for not using Thromboprophylaxis - by Major Patient Group
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Reasons for not using Thromboprophylaxis - by Province
28
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Reasons for not using Thromboprophylaxis - by Province and Major Patient Group
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Reasons for not using Thromboprophylaxis - by Province and Region
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1. Methodology
2. Audit participation
3. Appropriate thromboprophylaxis use
4. Types of thromboprophylaxis used
5. Reasons for not using appropriate thromboprophylaxis
6. Use of Preprinted order sets
7. Feedback and discussion
VTE Audit Day Results - Outline
31
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Preprinted Order Use - Overall Rates
32
N=4,667
55%
% of
pat
ient
s
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Preprinted Order Use – by Major Patient Group
33
% of
pat
ient
s
57% 51%
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Preprinted Order Use – by Province
34
% of
pat
ient
s
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Preprinted Orders – by Province and Major Patient Group
35
% of
pat
ient
s
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Preprinted Orders – by Province and Region
36
% of
pat
ient
s
100%
3%
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Receiving Appropriate Thromboprophylaxis and Preprinted Order Sets
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N=4,518
Order set used
Order set not used
91%
71%
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• 1st Canadian national VTE thromboprophylaxis audit
• 118 centres and 4,667 patients
• Coast to coast representation
• Medical and surgical patients well represented
Summary - Participation
38
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• Overall, thromboprophylaxis use = 81% - Very good (but with room for improvement)
• Variability in thromboprophylaxis use: - By patient group:
– General surgery 84% – Medical 79%
- By province: 65% 100%
- By region within provinces
Summary – Thromboprophylaxis Use
39
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Summary – Types of Thromboprophylaxis
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• Types of Thromboprophylaxis: • LMWH: 61% • LMWH + LDH: 90% • Mechanical only: 4%
• Variability: • By Patient Group:
• Medical: LMWH vs. LDH (70% vs 21%)
• Surgical: LMWH and LDH similar (45% and 46%)
• By province • By region within provinces
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• Overall: – 19% did not receive appropriate
thromboprophylaxis • Reasons:
• No thromboprophylaxis 70% • Delay in start 9% • Wrong dose 8% • Modality varied from SHN recommendation 6%
Summary – Reasons for not using Thromboprophylaxis
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• 55% of patients had admission / postop OS • Huge differences by province (13% 63%)
and region • Appropriate thromboprophylaxis was more
common if OS used (71% vs 90%)
Summary – Order set use
42
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• Some provinces not represented: – Quebec, NMT, Yukon, Nunavut
• Potential participation bias: – ?good centre bias – ?good nursing unit bias
• Snap shot Audit
Summary - Limitations
43
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1. Methodology
2. Audit participation
3. Appropriate thromboprophylaxis use
4. Types of thromboprophylaxis used
5. Reasons for not using appropriate thromboprophylaxis
6. Use of Preprinted order sets
7. Feedback and discussion
VTE Audit Day Results - Outline
44
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• Less than 20% response rate • 2/3 rated the tool at very good –
excellent • 2/3 indicated that they would continue to
use the tool to collect VTE data • 100% indicated they would participate in
another audit day next year • We still want to hear from you!
Feedback Survey link: http://survey.patientsafetyinstitute.ca/n/zzzfm.aspx
VTE Audit Day Feedback Survey
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Thank you!
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• Questions • Comments/suggestions • How can Safer
Healthcare Now! help you?
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Thank you!
Central Measurement Team metrics@saferhealthcarenow.ca
Virginia Flintoft – 416-946-8350 Alexandru Titeu – 416-946-3103
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