The Thrombosis Committee: an Instrument for Governance & Change

1. The Thrombosis Committee: an Instrument for Governance & Change Dr Roopen Arya King’s College Hospital, London

3. Health Committee recommendations 2005 • Thrombosis committee should be established in each hospital, with a specialist thrombosis team. • Modelled on existing Blood Transfusion teams and committees. • A basic standard of expectation should be issued by the DOH pending publication of NICE guidelines.

4. Health Committee recommendations 2005 • Thrombosis Committee: all interested parties including haematologists, surgeons, physicians, anaesthetists, obstetricians, nursing staff and pharmacists. • Ensure clinical governance and provide a local audit of thromboprophylactic procedures in each hospital.

5. Health Committee recommendations 2005 A potential draft remit of the Thrombosis Committee: • Promote best practice through local protocols based on national guidelines. • Lead multi-professional audit of the use of thromboprophylaxis focusing on specialties where risk is high. • Promote education and training of all clinical and support staff. • Have the authority to modify existing VTE and risk assessment protocols and to introduce appropriate changes to practice. • Consult with local patient representative groups where appropriate. • Contribute to the development of clinical governance.

6. Health Committee recommendations 2005 Thrombosis Teams would: • Assist in implementation of Thrombosis Committee’s objectives. • Promote and provide advice and support re: appropriate thromboprophylaxis and risk assessment. • Actively promote implementation of good thromboprophylaxis practice. • Be a source for training all hospital staff involved in dealing with patients at risk of VTE.

7. King’s’ experience • Anticoagulation/thrombosis committee • Established 1999, quarterly meetings • Multidisciplinary group: physicians, surgeons, imaging drs and technicians, nurse specialists, pharmacists • Instrument for clinical governance and driving change

8. Background • Adverse incidents related to anticoagulation • Awareness of mortality & morbidity due to VTE at King’s • ‘Ad hoc’ management of clinical thrombosis • Practice variations and lack of clear guidelines • Manage change - new anticoagulants and treatment strategies

9. Setting up a thrombosis committee: • Identify stakeholders within Trust • Multidisciplinary core group + invite relevant parties • Terms of reference • Resource implications • Decide on agenda: be focused

10. Agenda items • DVT and PE care pathways • New anticoagulant drugs • Choice of LMWH • Thrombolysis for PE • Thromboprophylaxis for surgical patients • Thromboprophylaxis for medical patients • Anticoagulation prescription charts • Audit of anticoagulation & thromboprophylaxis • Adverse incidents relating to anticoagulation

11. Achievements • Establishment of clinical thrombosis services • Policies for thromboprophylaxis and treatment of VTE • Policies regarding anticoagulation • Trustwide consensus & clinical guidelines • Promote clinical research • Resource for education and training • Vital part of the Trust framework for clinical governance & audit

12. Integrated Care Pathway for DVT

13. KCH guidelines for medical thromboprophylaxis