vte prevention and anticoagulation practice
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
-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