National VTE Audit Day: Results and Feedback

www.saferhealthcarenow.ca

National VTE Audit – October 2014

RESULTS

Bill Geerts & Artemis Diamantouros

Virginia Flintoft, Anne MacLaurin and Alex Titeu CPSI Central Measurement Team

Nov. 2014


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1. Methodology

2. Audit participation

3. Appropriate thromboprophylaxis use

4. Types of thromboprophylaxis used

5. Reasons for not using appropriate

thromboprophylaxis

6. Use of Preprinted order sets

7. Feedback and discussion

VTE Audit Results - Outline

5


• National VTE Audit: October 1-15, 2014

• Audit Sample:

– General Internal Medicine and General Surgery

• National webinar (Sept. 8) - Call to Action

• Engagement of sites & registration

• Sites contacted by CMT:

– Identification of audit sample

– Creation of data collection forms

VTE Audit - Overview

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• Launch of National VTE Audit:

• Data Collection: October 1 to 15

– Extension for data collection to October 31

– Data submission accepted up to November 7

• Error reports corrected and resubmitted by

Central Measurement Team (CMT)

• Data cleaning and Analyses conducted by CMT

with data from Patient Safety Metrics

(PS Metrics)

VTE Audit - Methodology

7


1. Methodology





thromboprophylaxis




8


Response Rate 2014 – Original and Cleaned

10

Originally

Submitted

Oct. 2014

Cleaned

Oct.2014

Sites 112 110

Patients 3,937 3,809


Overall Response Rate – 2013 v 2014

11

Apr.

2013

Oct.

2014

Sites 118 110

Patients 4,667 3,809


Responses by Province – 2013 v 2014

13


Responses by Major Patient Group –

2013 v 2014

16

2014 (n)=3,809

2013 (n)=4,667


1. Methodology





thromboprophylaxis




17


Receiving Appropriate TPX - Overall Rates

18

86% N=3,809

% o

f pati

ents


Appropriate TPX - By Major Patient Group

19

84%

92%

% o

f pati

ents

78% 86%


Receiving Appropriate TPX - by Province

20

% o

f pati

ents

Total (n)

National Average =86%


Receiving Appropriate TPX - by Province and Major Patient Group

21

% o

f pati

ents

Total (n)


Receiving Appropriate TPX - by Province and Region

22

Regions Reporting

National Average = 86%

% o

f pati

ents

Total (n)


1. Methodology





thromboprophylaxis



VTE Audit Day Results - Outline

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Type of Thromboprophylaxis - Overall

25

• LMWH = dalteparin; enoxaparin; fondaparinux; nadroparin; tinzaparin

• Other = apixaban; dabigatran; rivaroxaban; warfarin (2013=6%; 2014=7%)

Year Patients

on TPX

LMWH LDH Mech

Only

2013 3,619 61% 29% 4%

2014 2,601 60% 27% 6%


Type of Thromboprophylaxis - by Major Patient Group

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Patient

group

Patients on

TPX

LMWH LDH Mech

Only

Gen Med 1165 64% 24% 4%

Gen Surg 758 55% 33% 8%


Type of Thromboprophylaxis - by Province

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Total (n)


Type of Thromboprophylaxis - by Province and Major Patient Group

28

Total (n)


1. Methodology





thromboprophylaxis




29


Reasons for not using TPX - Overall

30

(73%)

(6%)

(4%)

(8%)

N=434

(7%)


Reasons for not using TPX - by Major Patient Group

31


1. Methodology





thromboprophylaxis




32


Preprinted Order Use –

Overall Rates – 2013 v 2014

34

N=3,809

49%

% o

f pati

ents

55%


Preprinted Order Use – By Major Patient Group

35

% o

f pati

ents

51% 46%


Preprinted Order Use – by Province

36

% o

f pati

ents

Total (n)

National Average =49%


Preprinted Orders – by Province and Major Patient Group

37

% o

f pati

ents

Total (n)


Appropriate Thromboprophylaxis and Preprinted Order Set Use

38

N=3,771 94%

78%


Receiving Appropriate Thromboprophylaxis and Preprinted Order Sets – 2013 & 2014

39

94%

78%

91%

71%


Receiving Appropriate Thromboprophylaxis and Preprinted Order Sets by Service

40

N=3,202

94%

96%

88%

75%


• 2nd Canadian national VTE

thromboprophylaxis audit

• 110 centres and 3,809 patients

• Coast to coast representation (almost)

• Medical and surgical patients well

represented

Summary - Participation

41


• After data cleaning 8 fewer sites participated

this year representing 858 fewer patients

• Half as many patients from Ontario and 3

times as many from AB; no data from NL but 5

sites from QC vs 0 in 2013

• 25% - 35% fewer cases reported for Gen. Med

and Gen. Surg; 50% - 68% more cases in Med-

Surg and Other Surg in 2014

Summary – 2013 vs 2014 Audits

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• No difference in proportional use of

Thrombolytics by type

• Slightly less use of Pre-printed Order Sets in

2014 (49% v 55%)

• Appropriateness of Thrombolytics was slightly

better in 2014

• Using Order Sets - 94% v 91%

• Not using Order Sets – 78% v 71%

Summary – 2013 vs 2014 Audits

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Summary of 2014 Data

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• Overall, thromboprophylaxis use = 86%

- Excellent response but still room for improvement

- 14% of patients at risk for VTE did not receive

appropriate thromboprophylaxis

• Variability in thromboprophylaxis use:

- By patient group:

– General Surgery 92%

– General Medicine 84%

- By province: 70% 96%

- By region across provinces: 55% 100%

Summary – Thromboprophylaxis Use

45


Summary – Types of Thromboprophylaxis

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• Types of Thromboprophylaxis: • LMWH: 60%

• LDH: 26%

• LMWH + LDH: 87%

• Mechanical only: 5%

• Variability:

• By Patient Group:

• Medical: LMWH vs LDH (64% vs 24%)

• Surgical: LMWH vs LDH (56% and 33%)

• By province

• By region


• Overall: – 14% did not receive appropriate thromboprophylaxis

• Reasons:

• No thromboprophylaxis 73%

• Delay in start 8%

• Wrong dose 5%

• Modality varied from SHN recommendation 7%

Summary – Reasons for not using Recommended Thromboprophylaxis

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• 49% of patients had admission / postop OS

• Huge differences by province (16% 69%) and

region

• Appropriate thromboprophylaxis more common

if OS used (94% vs 78%) – also in 2013

Summary – Order set use

48


• Territories not represented:

– NL, NWT, Yukon, Nunavut

• Some incomplete data submitted

• Potential participation bias:

– ?good centre bias

– ?good nursing unit bias

• Snap shot Audit

Summary - Limitations

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1. Methodology





thromboprophylaxis




50


Thank you!

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1. Questions

2. Comments/suggestions

and Learning

3. How can Safer

Healthcare Now! help

you?


Thank You / Merci

Evaluation Poll

Sondage d’évaluation


Thank you / Merci

Central Measurement Team [email protected]

Virginia Flintoft – 416-946-8350

Alexandru Titeu – 416-946-3103

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mailto:[email protected]