The Thrombosis Committee: an Instrument for Governance & Change Dr Roopen Arya King’s College Hospital, London

Health Committee recommendations 2005 Thrombosis committee should be established in each hospital, with a specialist thrombosis team. Modelled on existing Blood Transfusion teams and committees. A basic standard of expectation should be issued by the DOH pending publication of NICE guidelines.

Health Committee recommendations 2005 Thrombosis Committee: all interested parties including haematologists, surgeons, physicians, anaesthetists, obstetricians, nursing staff and pharmacists. Ensure clinical governance and provide a local audit of thromboprophylactic procedures in each hospital.

Health Committee recommendations 2005 A potential draft remit of the Thrombosis Committee: Promote best practice through local protocols based on national guidelines. Lead multi-professional audit of the use of thromboprophylaxis focusing on specialties where risk is high. Promote education and training of all clinical and support staff. Have the authority to modify existing VTE and risk assessment protocols and to introduce appropriate changes to practice. Consult with local patient representative groups where appropriate. Contribute to the development of clinical governance.

Health Committee recommendations 2005 Thrombosis Teams would: Assist in implementation of Thrombosis Committee’s objectives. Promote and provide advice and support re: appropriate thromboprophylaxis and risk assessment. Actively promote implementation of good thromboprophylaxis practice. Be a source for training all hospital staff involved in dealing with patients at risk of VTE.

King’s’ experience Anticoagulation/thrombosis committee Established 1999, quarterly meetings Multidisciplinary group: physicians, surgeons, imaging drs and technicians, nurse specialists, pharmacists Instrument for clinical governance and driving change

Background Adverse incidents related to anticoagulation Awareness of mortality & morbidity due to VTE at King’s ‘Ad hoc’ management of clinical thrombosis Practice variations and lack of clear guidelines Manage change - new anticoagulants and treatment strategies

Setting up a thrombosis committee: Identify stakeholders within Trust Multidisciplinary core group + invite relevant parties Terms of reference Resource implications Decide on agenda: be focused

Agenda items DVT and PE care pathways New anticoagulant drugs Choice of LMWH Thrombolysis for PE Thromboprophylaxis for surgical patients Thromboprophylaxis for medical patients Anticoagulation prescription charts Audit of anticoagulation & thromboprophylaxis Adverse incidents relating to anticoagulation

Achievements Establishment of clinical thrombosis services Policies for thromboprophylaxis and treatment of VTE Policies regarding anticoagulation Trustwide consensus & clinical guidelines Promote clinical research Resource for education and training Vital part of the Trust framework for clinical governance & audit

Integrated Care Pathway for DVT

KCH guidelines for medical thromboprophylaxis