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Mandatory Training: VTE prevention and anticoagulation practice

Mandatory Training: 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. Venous Thrombo-Embolism (VTE). VTE is a major public health

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Mandatory Training: VTE prevention and anticoagulation practice

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  1. Mandatory Training: VTE prevention and anticoagulation practice Mr A McSorley Lead Thrombosis Nurse RCHT

  2. -Risk assessment and VTE avoidance-RCA of hospital acquired VTE (HAT) -Thrombosis & anticoagulation guidance

  3. Venous Thrombo-Embolism (VTE) • VTE is a major public health • Issue & results in approximately • 60,000 deaths per year in the 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-thrombotic • symptoms within 3 years & 25% • will develop a VLU later in life • 25,000 die from a hospital • acquired VTE every year1 • 4 out of 5 DVTs are • undetected as their symptoms • mimic other conditions

  4. 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

  5. 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

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

  7. RCH-T Schema STEP FOUR – Document appropriateness of thrombo-prophylaxis • Assess and decide on the appropriateness of thromboprophylaxis • Tick completethe Risk Assessment Decision and Action box on admission to column 1 on the bottom of the prescription sheet,

  8. Monthly pharmacy audit

  9. EPMA: the problem and the answer • Currently requires a 4 page supplementary sheet, with RA on back page • Module due with Feb 2014 upgrade • Your support please

  10. Thrombosis Practitioner/facilitator Support the Risk assessment process HAT RCA -from July 2013 as part of CQUIN -reports to Divisions (via DQLG) DoH quality standards patient information Peri-operative anticoagulation Anticoagulation related bleeding

  11. RCA to date • Q2 = 90 RCA, preventable HAT = 13 • Q3 = 112 RCA, preventable HAT = 11 • 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

  12. 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

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