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What still needs to be achieved in the clinical situation?

What still needs to be achieved in the clinical situation?. VTE Symposium – sharing good practice 21 st September 2010. Dr Tamara Everington. What is your background?. Doctor Nurse Pharmacist Risk Manager Executive Other. NICE Quality Standard 1.

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What still needs to be achieved in the clinical situation?

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  1. What still needs to be achieved in the clinical situation? VTE Symposium – sharing good practice 21st September 2010 Dr Tamara Everington

  2. What is your background? • Doctor • Nurse • Pharmacist • Risk Manager • Executive • Other

  3. NICE Quality Standard 1 • “All patients, on admission, receive an assessment of VTE and bleeding risk”

  4. How do we crack the last 10%?

  5. Which 1 of these do you think is most likely to increase compliance with VTE risk assessment? • CQUINS targets • Executive Drivers • Better staff education • Electronic Systems • Productive Wards

  6. NICE Quality Standard 2 • “Patients are re-assessed within 24 hours of admission for risk of VTE and bleeding”

  7. How should you document repeat VTE RA at 24 hours? • Repeat the initial VTE RA document • Document in the clinical pathway (PTWR) • Pharmacy check • Nurse check • Other

  8. NICE Quality Standard 3 • “Patients assessed to be at risk of VTE are offered VTE prophylaxis in accordance with NICE guidance”

  9. Which groups would you adjust thromboprophylaxis dose in? • Renal impairment • Obesity • Cancer patients with cachexia • Recurrent “fallers” • All of the above • None of the above

  10. Which day cases do you plan to risk assess? • Day surgery under GA • Day surgery under LA • Fracture clinic • Chemotherapy patients • Medical day cases • 1,(2), 3 & 4 • All of the above

  11. In theory we could reduce secondary VTE by 65%?

  12. How will you pick up secondary VTE? • Via anticoagulant referrals • Via radiology reports of VTE • Via clinical coding • Via death certificates • Via the Coroner • Combination of the above?

  13. NICE Quality Standards 4 & 5 • “Patients / carers are offered verbal and written information on VTE prevention at time of admission…. & as part of the discharge process”

  14. Simples!!!! If only!!!

  15. What information is most likely to work? • Written information • Visual information • Face-to-face explanation • A mixture of the above

  16. NICE Quality Standard 6 • “Patients provided with anti-embolism stockings have them fitted and monitored in accordance with NICE guidance”

  17. Which of the following have you seen on patients? • Which of the following have you seen on patients? • Stockings causing a ‘tourniquet’ effect • Damaged legs from stockings • Soiled stockings • All of the above • “I wish you hadn’t asked that question”

  18. NICE Quality Standard 7 • “Patients receive extended postoperative VTE prophylaxis in accordance with NICE guidance”

  19. A 65 year old woman with a history of VTE has incurable ovarian cancer with reduced mobility which can be controlled with indefinite chemotherapy. • Not at all • Aspirin only • For 28 days following surgery • Indefinitely How long would you continue thromboprophylaxis?

  20. Root cause analysis – How do we do this?

  21. Which method of RCA do you think will be most effective? • RCA by the Thrombosis Committee • RCA by the VTE nurse • RCA by Clinical risk • RCA by Clinical teams

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