Title: VTE Assessments in Acute General Medicine at the John Radcliffe Hospital
1VTE Assessments in Acute General Medicine at the
John Radcliffe Hospital
Learning To Make a Difference
- Srimathy Vijayan
- CMT 1, John Radcliffe Hospital
2Rationale
- Encompassed in the NICE VTE guidelines (Jan 2010)
- Important issue
- Patient Safety - VTE prophylaxis shown to reduce
the number of deaths in patients - Trusts are monitored re. performance and
financial implications are great
3Project Aim(s)
- By July 2012, 100 of patients admitted via AGM
will have VTE assessments completed within 24
hours of admission - To ensure that in 100 of cases of those NOT on
VTE prophylaxis, there is clear documentation as
to why in the medical notes and a corresponding
online VTE assessment completed
4Action Planning
What are we trying to accomplish? All pts admitted via AGM will have VTE assessments completed within 24 hrs of admission For pts NOT on VTE (as per Drug chart) there is clear documentation in notes as to why not For pts not on VTE, a corresponding VTE assessment form was completed online
How will we know that a change is an improvement? By analysing end point data at various time points to evaluate the trends (before and after an intervention)
What changes can we make that will result in improvement? Appropriate awareness to all AGM Drs re. the importance of this topic by correspondence via Email Appropriate use of PTWR sheet (used at JR)
5Process mapping
Daily RV for need of VTE prophylaxis
Pt admitted to AGM
Appropriate prescription of VTE
Seen by Dr History, Examination,
Investigations, Diagnosis considered
Online completion of VTE assessment form
Management Plan including need for VTE
6Driver Diagram
VTE assessments in AGM
Education on Drs part
Access to case notes
Prescribing correctly in DC
Review by Seniors
Integral part of pt admission like DC/CXR
etc Reasons for VTE and NOT for VTE
Locums who do not have this must inform others
Appropriate dosing as per protocol
Review on PTWR using appropriate proforma
7Methods
- Performed at JR Hospital, Level 7 (AGM wards), 3
Wards selected - 5 patients on each ward randomly selected. For
each patient - Admission date noted
- Drug chart screened for VTE prescription
- For those who did NOT have VTE prescribed Medical
notes screened for explanation - Online system casenotes used to determine
whether VTE assessment was completed and on what
date - Those Pts not on VTE online case notes
assessment evaluated to see if it corresponds
with NOT needing VTE
8Methods contd
- Data Collection
- Baseline (Week 0), Week 1, Week 2, Week 3
- Intervention
- 1 day after Baseline data collected
- Consisted of Email to all Staff working on AGM
9Runchart
10Results
Number of Patients who were not on VTE and
percentage of those with reasons for no VTE
No of pts not on VTE No of pts for whom reason given
Week 0 (Baseline) 7 3 (43)
Week 1 9 4 (44)
Week 2 9 8 (89)
Week 3 6 6 (100 target)
11Results
Number of Patient who were not on VTE and had
correctly completed online VTE assessments
No of patient NOT on VTE No of patients with corresponding online VTE assessments
Baseline (week 0) 7 3 (43)
Week 1 9 2 (22)
Week 2 9 3 (33)
Week 3 6 4 (67)
12Discussion
- By Week 3, Target of 100 for VTE assessments
completed within 24 hours of admission achieved. - Ongoing Issues with poor documentation as to
why patients are not on LMWH - why? - For those patients not on VTE the online form
very rarely reflects no VTE required or offer
anti-embolic stockings only. In the Majority of
cases still filled out as needing prophylactic
VTE why?
13Next Steps
- What do you plan to do next?
- Continue data collection for a few further weeks
to evaluate trends - Discuss results with local Audit department
- Address the issues of poor documentation in notes
for those not on VTE perhaps at next AGM
clinical governance meeting? As well as need for
accurate VTE completion online and updating
issue - What has been the learning?
- The importance of the need to consider VTE in pts
admitted to hospital and the need to document in
those cases where you feel VTE not appropriate