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Improving VTE Risk Assessment and Compliance in Clinical Practice: Key Insights from the 2010 Symposium

The VTE Symposium held on 21st September 2010, led by Dr. Tamara Everington, focused on the challenges in achieving compliance with NICE quality standards for VTE risk assessment. It discussed critical strategies, such as staff education, electronic systems, and the documentation of repeated risk assessments. Additionally, the symposium explored the importance of offering appropriate VTE prophylaxis and effective communication with patients. Attendees engaged in discussions on improving clinical practices to address VTE risks, aiming for a substantial reduction in secondary VTE incidents.

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Improving VTE Risk Assessment and Compliance in Clinical Practice: Key Insights from the 2010 Symposium

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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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