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