Venous thromboembolism (VTE) in obstetrics Dr.Roaa H. Gadeer MD.
Venous Thromboembolism (VTE) Prevention Program · Education and Raising Awareness – Patient...
Transcript of Venous Thromboembolism (VTE) Prevention Program · Education and Raising Awareness – Patient...
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
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• Incidence 100 times greater in hospitalised patients than community residents
• 7% of hospital deaths
• Largely preventable
NSW Context
• Clinical Focus Report
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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
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7
0 2 4 6 8 10
Metropolitan
Rural and Regional NSW
NSW Context
• VTE database – HIE ICD-10 coded data
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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
149 cases Rural/Regional
1152 cases Rural/Regional
145 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
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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
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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
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What’s the Harm?
VTE
Mortality
Fatal PE
Morbidity
Readmission Increased LOS Post-thrombotic syndrome
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The Complexity
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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
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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
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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
Guidelines – PD and Framework
• Revised Prevention of Venous Thromboembolism Procedure
• Framework for the Prevention of VTE
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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
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
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Tools – VTE Risk Assessment Tool
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Tools – Electronic Support (eMR)
• Collaboration with eHealth
• Prompts/tasks, reminders
• Availability of electronic risk assessment tool
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Tools – Audit
• QARS System
• Assists in conducting quality audits
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Tools – Audit
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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
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Tools – Performance Management
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Hospital-
associated
VTEs
Coding
cannot
determine
Tools – Incident Management Tool • Non-SAC 1 incidents
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Tools – Revised NIMC
• ACQSHC
• Implemented state-wide
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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
Education and Raising Awareness – eLearning Module • Need for standardised education/training
• Status: Under development
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Education and Raising Awareness – Clinician Training • Short training piece
• JMO Induction
• Refresher
• Tutorials
• Ward/department education
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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
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Education and Raising Awareness – Patient Education
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Education and Raising Awareness – Posters • Raise awareness
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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
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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
Stop Clots, Stop Harm