Venous Thromboembolism (VTE) Prevention Program · Education and Raising Awareness – Patient Education •“….not given printed information regarding the incidence of VTE, recognised

Venous Thromboembolism (VTE) Prevention Program

Lillian George+

Project Officer,

Medication Safety and Quality CLINICAL EXCELLENCE COMMISSION

Venous Thromboembolism (VTE)

• 14,000 cases

• 5,000 deaths

• > deaths than bowel Ca and breast Ca

2

• Incidence 100 times greater in hospitalised patients than community residents

• 7% of hospital deaths

• Largely preventable

NSW Context

• Clinical Focus Report

3

SAC Rating SAC 1 SAC 2 SAC 3 SAC 4 No SAC

Allocated

TOTAL

Number of IIMS

Incidents

6 13 50 19 6 94

Additional RCA

Cases (SAC 1)

10 - - - -

16 13 50 19 6 104

9

7

0 2 4 6 8 10

Metropolitan

Rural and Regional NSW

NSW Context

• VTE database – HIE ICD-10 coded data

4

45

1152

2792

0 500 1000 1500 2000 2500 3000

Reported Incidents

Incidents Coded as Occuring DuringEpisode of Care

Incidents without Coding toDetermine Hospital-Associated or not

1 January - 31 December 2012

50

1077

2837

0 500 1000 1500 2000 2500 3000

Reported Incidents

Incidents Coded as Occuring DuringEpisode of Care

Incidents without Coding to DetermineHospital-Associated or not

1 January - 31 December 2013

1184 cases Rural/Regional




What’s the Harm?

• 71 year old male

• C/O: L hip pain

• Hx: recent L THR

• Underwent closed reduction

• L knee Zimmer splint

• Difficultly mobilising

5

What’s the Harm?

• 10 days post-op: noticed nil VTE prophylaxis

• Prophylaxis prescribed

• Physio

• Collapse and LOC MET

• Cardiac arrest deceased

• Coroner’s report: PE at time of death

6

What’s the Harm?

• Admitted for UTI and cellulitis

• Immobile during admission

• 9 days post-discharge re-presents

• Swelling, erythema to L lower leg

• Doppler: Extensive occlusive L leg DVT

• 5 day admission: IV heparin and commenced on warfarin

7

What’s the Harm?

VTE

Mortality

Fatal PE

Morbidity

Readmission Increased LOS Post-thrombotic syndrome

8

The Complexity

9

Underestimation of clotting risks

Limited evidence

Overestimation of bleeding risk

Lack of consensus

Limited guidelines/ protocols

Affects vast population

Lack of awareness

Time constraints

The Clinical Excellence Commission is committed to address this patient safety priority for NSW

10

11

The VTE Prevention Program

Guidelines

VTE Prevention Framework

Revised Policy Directive

Tools

VTE Risk Assessment Tool

Electronic support through eMR

Audit / performance monitoring tool

Non-fatal VTE Incident Management Tool

Revised NIMC with dedicated VTE section

Education and Raising Awarenss

eLearning module for clinicians

Educational resources for clinician training

Patient education material

Posters focused on patients, and clinicians

12


Guidelines



Tools











Guidelines – PD and Framework

• Revised Prevention of Venous Thromboembolism Procedure

• Framework for the Prevention of VTE

13

14


Guidelines



Tools











Tools – VTE Risk Assessment Tool

• Development

– State-wide testing

– Adaptation: San Diego Model, Dr Greg Maynard

– Expert Advice

“very easy to understand and very easy to use”

“Tool was great! Clear and precise, not too wordy but enough detail to feel comfortable using it”

• Status: SFMC – due for release soon

• Available for ordering

15

Tools – VTE Risk Assessment Tool

16

Tools – Electronic Support (eMR)

• Collaboration with eHealth

• Prompts/tasks, reminders

• Availability of electronic risk assessment tool

17

Tools – Audit

• QARS System

• Assists in conducting quality audits

18

Tools – Audit

19

Tools – Performance Management

• VTE Database

• HIE ICD-10 codes

• Hospital-associated VTE

• View data on: – Ward Level

– Facility Level

• Benchmark against: – Peer groups

– NSW benchmark

20

Tools – Performance Management

21

Hospital-

associated

VTEs

Coding

cannot

determine

Tools – Incident Management Tool • Non-SAC 1 incidents

22

Tools – Revised NIMC

• ACQSHC

• Implemented state-wide

23

24


Guidelines



Tools











Education and Raising Awareness – eLearning Module • Need for standardised education/training

• Status: Under development

25

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=k-8J6pzD-5z8WM&tbnid=vAbsE9VnDOyInM:&ved=0CAUQjRw&url=http://intranet.genetics.wisc.edu/2014/05/30/department-computational-research-server-coming-soon/&ei=4x4EVKjLOJS78gXpwIGACw&bvm=bv.74115972,d.c2E&psig=AFQjCNEQncBhr12BzdQUJUDT8zy-9xqrPw&ust=1409642546173178

Education and Raising Awareness – Clinician Training • Short training piece

• JMO Induction

• Refresher

• Tutorials

• Ward/department education

26

Education and Raising Awareness – Patient Education • “….not given printed information regarding

the incidence of VTE, recognised risk factors and how to identify and manage clinical symptoms…..had the woman been provided with this information she and her family may have sought an earlier medical review”

• Development with experts and consumer input

27

Education and Raising Awareness – Patient Education

28

Education and Raising Awareness – Posters • Raise awareness

29

Patient- targeted

Clinician- targeted

Education and Raising Awareness – Video • Raise awareness

• Clinician-focus

• Acknowledge St Vincent’s Hospital

• Available through website (along with all other resources and useful links)

www.cec.health.nsw.gov.au/vte-prevention

30

31


Guidelines



Tools











Stop Clots, Stop Harm

Thank you

33

For further information:

[email protected]

www.cec.health.nsw.gov.au/vte-prevention

Documents

Venous Thromboembolism (VTE) Prevention Program · Education and Raising Awareness – Patient Education •“….not given printed information regarding the incidence of VTE, recognised