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VTE Education, Education, Education!

This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab

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VTE Education, Education, Education!

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  1. This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation • In Slide Show, click on the right mouse button • Select “Meeting Minder” • Select the “Action Items” tab • Type in action items as they come up • Click OK to dismiss this box • This will automatically create an Action Item slide at the end of your presentation with your points entered. Colchester Hospital University NHS Foundation Trust VTE Education, Education, Education! J Cronin, S Majeed, E Morley-Smith, K Ganesh, S Ambrozie, M Wood, A Howard.

  2. The Problem

  3. Numerous Reports of Poor Prophylaxis Canada USA UK Australia & NZ UK USA USA UK USA - Belch et al 1981 - Conti & Daschbach 1982 - Jones 1991 - Fletcher et al 1992 - Stephens et al 1995 - Audet et al 1998 - Bratsler et al 1998 - George et al 1998 - Alizadeh & Hyman 2005

  4. Questionnaire Audit of Surgical Doctors Charing Cross and Hammersmith Hospitals 2002 • Aims - Assess prescription activities of surgical doctors for DVT prophylaxis • Questionnaire - 24 questions • Response rate - 100% (n=55) Howard et al EVF 2003

  5. Doctors Howard et al EVF 2003

  6. Surgical Speciality

  7. Doctors Prescribing Prophylaxis Howard et al EVF 2003

  8. Source of Information Howard et al EVF 2003

  9. Uncertainty of Prophylaxis Amongst Doctors91% Howard et al EVF 2003

  10. Thromboembolic Risk Assessment • 3 Case Scenarios • High VTE risk (n=2) • Moderate VTE risk (n=1) • 45% correct risk given • 69% prescribed heparin & stockings • 96% approved of a single prophylaxis protocol Howard et al EVF 2003

  11. Education and Awareness Programme CXH 2002 • Lectures to all surgical HO’s and SHO’s • Presentations to all surgical departments (twice) • New hospital consensus and protocol

  12. AUDIT OF CXH PROTOCOL Urology, GIT, Vascular and Breast Surgery (n=45) (n=34) (p=0.1) (p=0.03) (p=0.003)

  13. 2006 Audit of Compliance With Hospital Single Protocol Only 60 patients = 19% [95% CI 14-23%] n = 324

  14. Failure of Prophylaxis Application 233 patients Failed to receive GCS (72%) 151 patients Failed to receive LMWH (47%)

  15. Lessons Learnt! Sporadic education and audit does not maintain compliance in VTE Why? Silent disease until its too late Prevention is not exciting

  16. How Can The Situation Be Improved?

  17. Effective Strategy • Multifacted • Evidence-based protocols • Education • Risk assessment protocol • Computerised decision support • Audit with feedback • Specific staff for implementation

  18. New Programme 2008Colchester Hospital University NHS Foundation Trust • New Trust guidelines • Online risk assessment tool • e-learning and education programme • New Drug charts • Thrombosis committee • Audit all Trust inpatients (pre-launch & ‘rolling’) • Electronic alerts

  19. VTE CHUFT Website

  20. Laminated Handbook

  21. Education on Risk is Complex- Online Risk Assessment Tool • Patient details and date of admission • VTE risk factors • Contraindications to prophylaxis • Bleeding risk with LMWH • Printed version -> case notes

  22. Education & Awareness Programme • E-learning assessment (http://www.elearning-essexrivers.co.uk) • F1 and F2 teaching sessions • Nurse patient safety teaching sessions • Grand rounds • Clinical governance half-days • Electronic alerts in clinical areas

  23. Education & Awareness Programme • E-learning assessment (http://www.elearning-essexrivers.co.uk) • 70% pass mark • Certificate of completion

  24. Education & Awareness Programme E-learning assessment results • 45 completed – 44 doctors, 1 nurse • F1= 23, F2= 19, SpR = 2 • 25/45 achieved 70% on first attempt • 43/45 have completed (range 2-4 attempts)

  25. ‘Audication’ in VTE • Audit and vascular surgical department • 15 patients audited per week • Immediate feedback of results on ward-rounds • Hospital league table on intranet page/posters

  26. ‘Audication’ in Infection Control • Hand Hygiene Officer • 20+ surgical patients per week • Immediate feedback of results on ward-rounds • Surgical league table on infection control board

  27. The Clean Practice Protocol Educational Poster

  28. ‘Audication’Rounds 1 & 3

  29. Hand Washing Round 1 & 3 n=182

  30. The Next Steps

  31. Patient Education • ‘Stop the Clot’ campaign • Patient information with hospital TCI letter • Focus Groups • Media help

  32. Maintaining Practice • Maintenance of prophylaxis and risk assessment compliance • Continued education and awareness • Appointment of DVT Nurses for Prophylaxis and Treatment • Clinical Governance sessions • E-learning assessment study • Improve patient education and awareness

  33. Education, Education! Audication?

  34. Mr Adam Howard Dept of Vascular and Laparoscopic Surgery adam.howard@colchesterhospital.nhs.uk Mobile 07507646586

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