Preventing VTE in hospitalised patients Dr Roopen Arya Kings College Hospital

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Preventing VTE in hospitalised patientsDr
Roopen AryaKings College Hospital
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Preventing VTE in hospitalised patients

• Hospitalised patients at high risk of VTE
• VTE leads to substantial cost, mortality and
  morbidity
• Effective, safe and cost-effective measures to
  prevent hospital-acquired VTE exist
• Roadmap is in place
• Gap between current practice and optimal practice
  remains large
• Summary
  AHRQ report, 2008

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Thrombosis prevention in the UK
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VTE prevention a global initiative
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Implementing national VTE guidanceprogress

• Implementation Working Group
• Exemplar Centres
• Thrombosis committees local guidelines
• Thrombosis teams
• VTE Risk assessment

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VTE Implementation Working Group

• Established by CMO
• A Thomas (Chair), R Arya, T Baglin, A Flowerdew,
• A Kakkar, E Nicol, T Brown (Coordinator)
• Provide oversight and leadership for
  implementation of national VTE strategy in the
  NHS and wider healthcare sector
• Work closely with stakeholders such as NICE and
  HCC to ensure risk assessment of all hospitalised
  patients

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VTE Implementation Working Group

• Develop a national VTE risk assessment tool
• Develop Exemplar Centres
• Raising awareness
• Education

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Prevention of VTE in hospitalised patients
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Documented risk assessment for all hospitalised
patients
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http//healthguides.mapofmedicine.com/
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Introduction of computer system
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VTE prevention real-world practice

• ENDORSE survey (2008)
• 52 patients at risk for VTE
• 50 receiving prophylaxis
• (surgical 59 medical 40)
• APPTG survey(APPTG 2nd Annual Audit, 2008)
• 99 acute Trusts were aware of CMOs
  recommendations and
• NICE guideline
• 70 undertaking documented mandatory risk
  assessment
• 86 have thrombosis committees
• 87 educate staff re risk of VTE
• VERITY survey
• 94 have thrombosis committees
• gt80 have guidelines for medical and surgical
  thromboprophylaxis
• lt10 to 95 patients risk assessed for VTE
• 1 in 8 using DH VTE risk assessment

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VTE Exemplar Centres

• Resource for demonstration of best practice
• Based within hospitals or networks with an
  existing track record of excellent VTE management
• Expanded role including quality control, audit
  and education
• Help develop national risk assessment strategy,
  audit tools, centralised educational material to
  support local programmes
• Kings College Hospital was first NHS exemplar
  centre the London Clinic in the independent
  sector
• Network of exemplar centres being developed
• 8 exemplar centres at end of 2008

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VTE Exemplar Centres Requirements

• Chief Executive agreement / support
• Mechanism in place for VTE risk assessment
• Audit trail evidence of prevention management
  across organisation
• Multidisciplinary team approach
• Education and raising awareness re VTE
• Ability to act as a resource to spread good
  practice
• To apply e-mail roopen.arya_at_kcl.ac.uk

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VTE exemplar centres main elements

• Thrombosis committees
• Thrombosis teams
• Implementation of VTE risk assessment and
  thromboprophylaxis
• Audit
• Education and awareness
• Clinical research into VTE

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VTE exemplar centres in action

• Models of care
• Excellence at prevention of VTE in hospitalised
  patients
• Comprehensive care of VTE
• VTE prevention in the community
• Exemplars will include
• NHS Hospital Trusts
• Primary Care Trusts
• Strategic Health Authorities
• Independent sector

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VTE Exemplar Centres
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Exemplar centres education and awareness

• Local activities and training
• E-learning modules
• http//www.elearning-essexrivers.co.uk
• http//doctors.net.uk/education
• e-Learning for Healthcare VTE module in
  progress
• Lecturing at national courses on
  thromboprophylaxis
• Hertfordshire Birmingham
• NHS Choices video on DVT http//www.nhs.uk/vide
  o

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Exemplar centres education and awareness

• Meetings and workshops
• VTE awareness symposium at the London Clinic
• 26th Sept 2008
• - First national VTE exemplar centre study day
• 18th March 2009 at the Royal Society of Medicine
• VTE, a key patient safety issue Patient Safety
  Congress 1st May 2009 _at_ the ICC, Birmingham
• Workshops for nurses and pharmacists planned

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VTE exemplar centre websitewww.kingsthrombosiscen
tre.org.uk
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Developing a systems-based approach to the
prevention of VTE in hospitalised patients
Patient admitted to hospital
What will success look like?
Professional workforce aware of VTE risk
Individual patient risk assessed for VTE
Appropriate preventative strategy implemented
Evaluation of outcome
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