Transcript VTE Audit - Health in Wales

VTE Audit
Dr Thomas Lloyd F1
Dr Aman Hargehandewal
Wrexham Maelor Hospital
What is VTE?
• Collective term for deep vein thrombosis and pulmonary embolism.
• DVT is common but causes symptoms in 1/1000 a year in general
population.
• PE often results from asymptomatic DVT- can be fatal, or if not can
delay discharge and increase morbidity.
• Resolved DVT can cause post thrombotic complications (ulcers,
swelling etc)
Guidelines
• NICE guidelines recommend every
patient admitted to be hospital
should be assessed for VTE
prophylaxis.
• Patients should be reassessed at
24hrs, if their condition changes and
before discharge.
Aims and standards
Aims
• All patients should be assessed on admission to hospital to identify those who are at
increased risk of venous thromboembolism (VTE)
• All patients should be assessed for risk of bleeding before offering pharmacological VTE
prophylaxis
• The risks of bleeding and VTE should be reassessed within 24 hours of admission.
Data
• Will assess drug charts for completion of requirement and prescription of VTE prophylaxis
on all patients on Fleming, Lister and SAU wards
• Will include medical and surgical patients
• Will compare on call surgical patients to surgical and medical inpatients
• Will not include reviewing of patient notes
Data
• Data collected from Lister,
SAU and Fleming wards
• Empty or unoccupied beds
were those where the bed
had been vacated or the
patient had been taken to
theatre at time of data
collection.
1
14
empty or unoccupied
70
11On call
6Medical
53Inpatient
patients included
missed
Results
Percentage of patients prescribed some form of VTE
prophylaxis
90.00
88.00
86.00
84.00
82.00
80.00
78.00
On call
Surgical
Medical
Results
1
3
8
7
19
Teds
18
Clexane
Front of chart
filled in
Front of chart
not filled in
Both
none
Warfarin
33
Therefore standards currently not being met
50
Front of chart
differs from
prescribed
Prophylaxis prescribed as a percentage?
70
60
50
40
30
20
10
0
%Teds
%clexane
On call
%both
% front filled % no VTE
in
prophylaxis
Surgical
Medical
TEDs prescription
35
32
30
24
25
20
Total teds prescribed
Teds on
15
Teds on no px
10
8
5
5
1
2
0 0 0
0
On call
Surgical
Medical
Further Results
• 1 patient was written up for teds and enoxaparin, but it had not been
signed.
• 1 patient had TEDS and enoxaparin written on the front of their chart,
but only enoxaparin prescribed
• None of the warfarinised patients (3) had mechanical VTE prophylaxis
prescribed.
Conclusions
• Currently standards not being met.
• Not all patients are having VTE assessments completed on the front
of their charts.
• Not all pts are being prescribed VTE.
• Patients may not be adequately being re-assessed for VTE prophylaxis
• Many patients who could have mechanical prophylaxis are not having
it.
• Some patients are being given TEDS without prescription which could
potentially be hazardous.
Limitations
• Audit only performed on one day- there may be variation in on-call
team prescriptions
• Not all NICE recommended VTE audit points were covered during this
audit
• This audit did not differentiate between elective and emergency
surgical admissions amongst the surgical inpatients.
• Medical notes were not consulted as to reasoning for no prophylaxistherefore it is difficult to assess whether absence of prophylaxis
appropriate in some cases.
Recommendations
• Continuing staff education as to importance of VTE prophylaxis
• VTE assessment tool as part of drugs charts or as part of a surgical
admission booklet
• As of April 2016, there is going to be a revision of the All Wales Drug
Chart which will have a VTE prophylaxis assessment as part of the
chart
• It is therefore recommended that this topic be re-audited following
the adoption of this chart.
References
• National Institute for Health and Clinical Excellence. Venous
thromboembolism: reducing the risk. Reducing the risk of venous
thromboembolism (deep vein thrombosis and pulmonary embolism)
in patients admitted to hospital. NICE clinical guideline
92.London: NICE publications, 2010.
https://www.nice.org.uk/guidance/cg92
• http://howis.wales.nhs.uk/sitesplus/documents/861/acute_surgical_intera
ctive1.pdf (Acute surgical admission form 1000 lives)
• http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.
dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/doc
uments/digitalasset/dh_113355.pdf (DoH VTE assessment guideline)