Hospital acquired Hospital acquired VTE Alert system VTE Alert system Caroline Baglin Caroline Baglin Thrombophilia CNS Thrombophilia CNS
Jan 11, 2016
Hospital acquired Hospital acquired
VTE Alert systemVTE Alert system
Caroline BaglinCaroline Baglin
Thrombophilia CNSThrombophilia CNS
‘Venous thromboembolism is the number one cause of unexpected hospital death… the disconnect between evidence & execution as it relates to DVT prevention amounts to a public health crisis. We need to deliver a more unified, co-ordinated & stronger message: VTE prophylaxis in high risk patients is mandatory, not optional’
Samuel Z Goldhaber 2007
The drive to setting up the system
Venous thrombosis: reducing the burden of disease
The 10 hurdles
• perception of problem by clinicians – belief• agreement on RAM• agreement on intervention• extended prophylaxis• who assesses & prescribes?• training & competency• implementation – compliance, documentation, monitoring• funding – not a DOH target• change management – NHS culture• patient empowerment & engagement
Why?
• Argument that surgeons state no VTE post their operations
• They do not class below knee DVT as a thrombosis
• Readmitted with VTE under physicians so don’t know follow up
• Different interpretations of Thrombophylaxis
Our Audit Outcome – Identifies patients with hospital
acquired VTEProcess – Looks to see if RAM was applied
Tells us: 1 Outcome reducing2 Is process being applied3 Is process effective
Identification
• ICD codes• Post mortem• Radiology• Outpatient anticoagulant service
ICD codes
• Permits tracking of new diagnoses • I26 pulmonary embolism• I80 thrombophlebitis
Post mortem reviews
Monthly listReview cause of death - PECould death have been prevented?Limitations
Radiology
• Monthly list of scans, CTPA, VQ, US
Outpatient anticoagulant service
All patients discharged from hospital and referred to clinic
All patients newly registered with service
LOOK BACK – LOOK BACK – Hospital Acquired VTEHospital Acquired VTE
Look Back – Hospital acquired VTE
Feedback to clinical staff- process & outcome
Profile the ‘at risk patient’
LOOK BACK – LOOK BACK – Hospital Acquired VTEHospital Acquired VTE
LOOK BACK – LOOK BACK – Hospital Acquired VTEHospital Acquired VTE
• This look back is sent on behalf of the Outpatient Anticoagulant Service. The purpose is to give feedback to Clinicians on process and outcome, and allow us to develop a better profile of the ‘at risk’ patients.
• Therefore the form should NOT be placed in patients hospital notes or recorded on EMR.
• Signed + Clinical directors name
Lessons learnt so far
• Surgeons
• Physicians
Conclusions
• Need more uniformity within Trust.• Thrombophylaxis in all ‘in patients’ needs to be
addressed to try to reduce death rate due to VTE.• Baseline assessment of the 50 clinical
directorates.
Will ‘Look Back’ change practice?
?