Improving the multidisciplinary care and management of patients at risk of venous thromboembolism (VTE) NIHR Collaborations in Leadership in Applied Health Research and Care for South Yorkshire, Translating Knowledge into Action VTE Project Kate Bray, Marie Lowe, Kate Gerrish, Gemma O’Carroll, Sara Laker Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)

Non Fatal VTE in UK Costs £640 million pounds a year to treat complications associated with VTE Around 161 new cases of DVT are diagnosed in the UK per day In the UK it is estimated that there are 59,000 new cases of DVT and 29,500 new cases of non fatal PE a year NHS trusts have paid out £110million in compensation to sufferers of hospital- acquired DVT over the past six years 13 July 2011 Identifying priorities with NHS partners Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)

Co-producing & managing a project Engaging executive leads VTE Steering Group Patient and public involvement Medical staff Ward staff Management staff (Performance manager, Matrons, Business & service managers) Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)

Baseline data Knowledge & attitudes questionnaire Root cause analysis Assessment and compliance audit Development of policies & procedures Education and training Quality improvement teams Patient information Implementation Making the best evidence locally relevant Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)

Initial findings Knowledge was limited but has improved Medication knowledge was good but then decreased Prevention was not seen as a clinical priority but this is changing Knowledge & attitudes Patients received prophylaxis & still developed VTE Estimation that 50% of people develop VTE in the community Root cause analysis Initially risk assessment compliance was poor & prescribing of chemical prophylaxis was excellent Risk assessment has improved significantly to attain CQUIN / patient safety targets Other aspects that are improving is provision of patient information, prescribing of anti embolic stockings Compliance Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)

Challenges NHS reconfiguration Infrastructure Electronic patient record Benchmarking Policies & procedures Ward ownership Changes in DoH standards Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)

Impacts & outputs Achieving CQUIN 90% target consistently ResourcesStudy days Public awareness events Policies and procedures Audit tools Monitoring & compliance databases Patient information Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)

Final touches Evaluation of standard & aphasic friendly patient information Final ward feedback Gaining endorsement for patient information from Lifeblood Charity Internet & intranet VTE website Health economics Summative evaluation of the project Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)

Spread and sustainability Executive leadership VTE Steering Group Care pathway VTE exemplar site Education & training Team climate inventory Safety thermometer Publications Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)

The NHS Confederation (2009) Briefing Paper: Reducing Deaths from Blood Clots in Hospitals Available at: Department of Health (2008) Risk Assessment for Venous Thromboembolism London: Department of Health Available at: House of Commons Health Committee (2005) The Prevention of Venous Thromboembolism in Hospitalised Patients London :TSO Available at: National Institute for Health and Clinical Excellence (NICE) (2010) CG92 Venous Thromboembolism Reducing the Risk of Venous Thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital London: NICE Available at: References Nice Clinical Guidance VTE Exemplar Centre Network Lifeblood Links Dr Tricia Bain (Director of Quality & Standards RFT) Marilyn Gambles (PPI) Claire Bratley (PACS/RIS Administrator RFT) VTE Steering Group (RFT) NIHR CLAHRC for South Yorkshire acknowledges funding from the National Institute for Health Research. The views and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health. NIHR CLAHRC for SY would also like to acknowledge the participation and resources of our partner organisations. Further details can be found at Acknowledgments Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC-SY)