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Working together to achieve nursing excellence in VTE Katrina Glaister Clinical Governance Facilitator (VTE Project Nurse) Salisbury NHS Foundation Trust
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VTE prophylaxis in Salisbury Who are we? Where we were Where we are now Top tips!
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Salisbury NHS Foundation Trust 500 beds. 200, 000 people locally Specialist services to 3 million people Spinal Unit services to 11 million people.
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Where we were ….. July 2007 Policy VTE Working Group Aim: to develop a simple (evidence based) tool to assess VTE risk, implement and measure progress (improvement)
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Where we are now….. Demonstrated sustained improvement - Exemplar site VTE nurse (part time) VTE policy – Trust-wide Risk assessment + patient self-assessment Audit +++ Education, education, education Patient information Thrombosis Committee
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VTE Risk Assessment Local practice Aim - one tool Orthopaedics, palliative care, plastics, haematology & urology Orthopaedics (oral prophylaxis)
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Risk Assessment – documentation Wanted it simple! Audit Who assesses in Salisbury? Surgery – nurses Medicine – doctors Either way, nurses are key
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VTE prophylaxis Low risk = advice only High risk = fixed dose low molecular weight heparin (LMWH) unless contraindicated (if so then GCS if OK) If high risk + history of previous VTE - LMWH plus GCS
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Can patients self-assess? Outpatients in: Fracture clinic, Day Surgery, Oncology Can patients self-assess? Outpatients in: Fracture clinic, Day Surgery, Oncology
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Audit Pharmacists central to our success Trust-wide audit Reporting: Celebrated good practice League tables Clinical Governance newsletters Published article
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Education & raising awareness Staff 1:1, ward-based, awareness days, symposium, Clinical Governance Sessions, screen saver, Hospital Rounds, Junior Doctors, Physiotherapists, M&M meetings, feedback from incidents, RCA for all secondary VTE events …. Patient stories Patients are key! Governor on Thrombosis Committee, DVD, written information, plasma screens, Patientline/Hospedia, Foundation Constituency meetings, Annual Review article, Health Fairs, AGM ……. Message is : Get out of bed ASAP Exercise if on bed-rest Take deep breaths Stay hydrated.
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An informed public? Terminology – the general public vaguely understand what DVT is, but not VTE From a member of public at a Wiltshire Health Fair “VTE is the thing you get on a plane or when you have an operation and three weeks later you die”
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An informed public? I've heard of a DVT – what is a VTE? Is VTE the new buzz word? Is VTE a breakfast cereal? - I've heard of DVT - a pain in the leg!' I still call it DVT - never heard of VTE Never heard of VTE - is it when you have thick blood? They changed it did they? I knew DVT! I've had 3 DVTs - I wouldn't know VTE - I had sticky blood as part of Lupus
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Educating patients Written patient information: Average reading age in UK is around 11 years Health literacy is recognised as a problem in UK and elsewhere Coming into hospital patients are given many information sheets – do they read them? “Oh yes, I did get one of those, I sent it home with the wife, she’s much more interested in that sort of thing than me”
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Information must be accessible
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1 = Policy approved, 2 = Policy launched, 3 = Audit data presented to wards as league tables, 4 = Intensive education & link nurse programme, 5 = Executive drivers & pharmacy mandate (no RA = no drugs) 1 2 3 4 5
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Deaths with VTE at Salisbury 2007- 2009 0 2 4 6 8 10 12 Oct 07 - Mar 08 Apr 08 - Sep 08 Oct 08 - Mar 09 Apr 09- Sep 09 number of deaths Deaths with VTE Deaths from VTE
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20 secondary VTE, 5 PE* Oct 09-date
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VTE in the Southwest
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Top tips Patient stories are a powerful learning tool/motivator Regular early reinforcement about VTE ‘at the coal face’ ensures that risk assessment is embedded Build ‘change’ into normal practice Audit – essential and time consuming – IT helps! Semi-competitive ‘league tables’ increase compliance Provide VTE outcome data directly to staff Executive endorsement ensures that work progresses Work in progress, there is more to do!
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Bottom line – drip feed!
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