Orthopaedic Venous Thromboembolism (VTE) Prophylaxis ...€¦ · • Abdullah Omari – Project...

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Orthopaedic Venous Thromboembolism (VTE) Prophylaxis Improvement Project Aim Statement: In 6 months, 100% of all admitted orthopaedic patients in the orthopaedic ward will receive appropriate VTE prophylaxis Background Major orthopaedic surgery is associated with a very high risk of post-operative VTE Despite the awareness of the risks of VTE to admitted hospital patients and the presence of strategies to reduce this risk, rates of thromboprophylaxis are not ideal Team members Project Team Abdullah Omari – Project leader John Rooney – Head of Orthopaedic Department Nicola Jackson - VTE CNC Phoebe Huestis - NUM Orthopaedics Vascular Medicine Registrar Levina Saad/Catalina Bahamon Rivera - Orthopaedic CNE Paula Evangelista - VTE Clinical Lead Emma Pauley - Orthopaedic Physio Aarthmi Jeyachandran - Pharmacist Katherine Paulette - Ortho Care Coordinator Anthony Grabs – Executive sponsor Prof Abdullah Omari Executive Clinical Director | Head of Vascular Medicine Department | Senior Staff Specialist St. Vincent’s Hospital, Sydney [email protected] (02) 8382 6634 ECLP Cohort 18 Results Sustain change and dissemination Sustain change Standardisation Orthopaedic patients admitted to the orthopaedic ward Standardised and validated approach to VTE prophylaxis Documentation Risk assessment in the notes SIBR documentation regarding VTE prophylaxis Measurement Ongoing audit of patients Training VTE prophylaxis part of the orthopaedic JMO orientation VTE orientation for nursing staff on ward Dissemination ACI Innovation Exchange 2018 SVHA Innovation and Excellence Awards Link to National Standard Upcoming Venous Thromboembolism Prevention Clinical Care Standard (being finalised) https://www.safetyandquality.gov.au/our-work/clinical-care- standards/venous-thromboembolism-prevention-clinical-care- standard/ Literature review Prevention of Venous Thromboembolism - NSW Health www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2014_032.p df Kearon et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest: 2016; 49,2: 315-352 http://www.cec.health.nsw.gov.au/patient-safety-programs/adult- patient-safety/vte-prevention Results continued Discussion and Outcomes: The stretch goal of 100% was not achieved Improved appropriate VTE prophylaxis Initial rate was 71.4% increasing to 75% at the end of the study mainly in chemical prophylaxis Improved VTE risk assessment: Initial rates of risk assessment only 6.1% Almost four-fold increase by end of the study to 21.8% Stakeholder knowledge Improved knowledge of orthopaedic staff No excessive chemical prophylaxis or bleeding Proportion of orthopaedic patients on the orthopaedic ward was reduced during the study due to ward amalgamation Adverse effect on study results heterogenous patient group and differing nurse expertise 71.4% 59.1% 73.3% 92.9% 85.7% 77.8% 75.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% JUN-17 JUL-17 AUG-17 SEP-17 OCT-17 NOV-17 DEC-17 Ward change JMO JMO JMO 90.5% 95.5% 80.0% 100.0% 100.0% 88.9% 93.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 81.0% 63.6% 93.3% 92.9% 85.7% 88.9% 81.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 4.8% 4.5% 13.3% 0.0% 0.0% 11.1% 0.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 No adverse bleeding events 91% 90% 92% 96% 97% 91% 85% 56% 60% 68% 55% 57% 45% 41% 0% 20% 40% 60% 80% 100% June July August September October November December % of total orthopaedic patients % orthopaedic patients to other specialties on orthopaedic ward 40% 80% 88% 88% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Correct contraindiciations Correct prophylaxis Outcome measure: Appropriate VTE prophylaxis Appropriate mechanical VTE prophylaxis Process measures: Appropriate pharmacological VTE prophylaxis Process measures: Knowledge Balancing measures: Excessive pharmacological VTE prophylaxis Proportion of patients on orthopaedic ward 22% 33% 11% 100% 22% 80% 80% 40% 100% 80% 0% 20% 40% 60% 80% 100% Teach the patient how to reapply the stocking Check the patient's circulation Prescribe in MedChart Write in the nursing care plan Give the patient a leaflet on the use of GCS Pre education Post education Survey of orthopaedic consultants’ knowledge Survey of nursing staff regarding anti-embolic stockings Documented VTE risk assessment 6.1% 20.4% 35.5% 20.2% 18.0% 7.9% 21.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

Transcript of Orthopaedic Venous Thromboembolism (VTE) Prophylaxis ...€¦ · • Abdullah Omari – Project...

Page 1: Orthopaedic Venous Thromboembolism (VTE) Prophylaxis ...€¦ · • Abdullah Omari – Project leader • John Rooney – Head of Orthopaedic Department • Nicola Jackson - VTE

Orthopaedic Venous Thromboembolism (VTE) Prophylaxis Improvement Project

Aim Statement: • In 6 months, 100% of all admitted orthopaedic patients

in the orthopaedic ward will receive appropriate VTE prophylaxis

Background• Major orthopaedic surgery is associated with a very high

risk of post-operative VTE• Despite the awareness of the risks of VTE to admitted

hospital patients and the presence of strategies to reduce this risk, rates of thromboprophylaxis are not ideal

Team membersProject Team • Abdullah Omari – Project leader• John Rooney – Head of Orthopaedic Department• Nicola Jackson - VTE CNC• Phoebe Huestis - NUM Orthopaedics• Vascular Medicine Registrar• Levina Saad/Catalina Bahamon Rivera -

Orthopaedic CNE • Paula Evangelista - VTE Clinical Lead• Emma Pauley - Orthopaedic Physio• Aarthmi Jeyachandran - Pharmacist• Katherine Paulette - Ortho Care Coordinator• Anthony Grabs – Executive sponsor

Prof Abdullah Omari Executive Clinical Director | Head of Vascular Medicine Department | Senior Staff Specialist St. Vincent’s Hospital, Sydney [email protected] (02) 8382 6634 ECLP Cohort 18

Results

Sustain change and disseminationSustain change• Standardisation

• Orthopaedic patients admitted to the orthopaedic ward• Standardised and validated approach to VTE prophylaxis

• Documentation• Risk assessment in the notes• SIBR documentation regarding VTE prophylaxis

• Measurement • Ongoing audit of patients

• Training• VTE prophylaxis part of the orthopaedic JMO orientation• VTE orientation for nursing staff on ward

Dissemination• ACI Innovation Exchange • 2018 SVHA Innovation and Excellence Awards

Link to National Standard• Upcoming Venous Thromboembolism Prevention Clinical Care

Standard (being finalised)• https://www.safetyandquality.gov.au/our-work/clinical-care-

standards/venous-thromboembolism-prevention-clinical-care-standard/

Literature review• Prevention of Venous Thromboembolism - NSW Health

www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2014_032.pdf

• Kearon et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest: 2016; 49,2: 315-352

• http://www.cec.health.nsw.gov.au/patient-safety-programs/adult-patient-safety/vte-prevention

Results continued Discussion and Outcomes:• The stretch goal of 100% was not achieved

• Improved appropriate VTE prophylaxis• Initial rate was 71.4% increasing to 75% at the end of the study

mainly in chemical prophylaxis

• Improved VTE risk assessment:• Initial rates of risk assessment only 6.1%• Almost four-fold increase by end of the study to 21.8%

• Stakeholder knowledge• Improved knowledge of orthopaedic staff

• No excessive chemical prophylaxis or bleeding

• Proportion of orthopaedic patients on the orthopaedic ward was reduced during the study due to ward amalgamation • Adverse effect on study results • heterogenous patient group and differing nurse expertise

71.4%59.1%

73.3%

92.9% 85.7%77.8% 75.0%

0%10%20%30%40%50%60%70%80%90%

100%

JUN-17 JUL-17 AUG-17 SEP-17 OCT-17 NOV-17 DEC-17

War

d ch

ange

JMO

JMO

JMO

90.5% 95.5%

80.0%

100.0% 100.0%

88.9%93.8%

0%10%20%30%40%50%60%70%80%90%

100%

Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

81.0%

63.6%

93.3% 92.9% 85.7% 88.9%81.3%

0%10%20%30%40%50%60%70%80%90%

100%

Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

4.8% 4.5%13.3%

0.0% 0.0%

11.1%

0.0%0%

10%20%30%40%50%60%70%80%90%

100%

Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

No adverse bleeding events

91% 90% 92% 96% 97%91% 85%

56% 60%68%

55% 57%45% 41%

0%

20%

40%

60%

80%

100%

June July August September October November December

% of total orthopaedic patients

% orthopaedic patients to other specialties on orthopaedic ward

40%

80%88% 88%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Correct contraindiciations Correct prophylaxis

Outcome measure: Appropriate VTE prophylaxis

Appropriate mechanical VTE prophylaxis

Process measures:Appropriate pharmacological VTE prophylaxis

Process measures:Knowledge

Balancing measures:Excessive pharmacological VTE prophylaxis

Proportion of patients on orthopaedic ward

22%

33%

11%

100%

22%

80% 80%

40%

100%

80%

0%

20%

40%

60%

80%

100%

Teach thepatient howto reapply

the stocking

Check thepatient's

circulation

Prescribe inMedChart

Write in thenursing care

plan

Give thepatient a

leaflet on theuse of GCS

Pre education Post education

Survey of orthopaedic consultants’ knowledge Survey of nursing staff regarding anti-embolic stockings

Documented VTE risk assessment

6.1%

20.4%

35.5%

20.2% 18.0%

7.9%

21.8%

0%10%20%30%40%50%60%70%80%90%

100%

Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17