1. Hospital acquired VTE Alert system Caroline Baglin Thrombophilia CNS

2. ‘Venous thromboembolism is the number one cause of unexpected hospital death… the disconnect between evidence & execution as it relates to DVT prevention amounts to a public health crisis. We need to deliver a more unified, co-ordinated & stronger message: VTE prophylaxis in high risk patients is mandatory, not optional’ Samuel Z Goldhaber 2007

3. The drive to setting up the system

4. Venous thrombosis: reducing the burden of disease The 10 hurdles perception of problem by clinicians – belief agreement on RAM agreement on intervention extended prophylaxis who assesses & prescribes? training & competency implementation – compliance, documentation, monitoring funding – not a DOH target change management – NHS culture patient empowerment & engagement

5. Why? Argument that surgeons state no VTE post their operations They do not class below knee DVT as a thrombosis Readmitted with VTE under physicians so don’t know follow up Different interpretations of Thrombophylaxis

6. Our Audit Outcome – Identifies patients with hospital acquired VTE Process – Looks to see if RAM was applied Tells us:1Outcome reducing 2Is process being applied 3 Is process effective

8. Identification ICD codes Post mortem Radiology Outpatient anticoagulant service

9. ICD codes Permits tracking of new diagnoses I26pulmonary embolism I80thrombophlebitis

10. Post mortem reviews Monthly list Review cause of death - PE Could death have been prevented? Limitations

11. Radiology Monthly list of scans, CTPA, VQ, US

12. Outpatient anticoagulant service All patients discharged from hospital and referred to clinic All patients newly registered with service

13. LOOK BACK – Hospital Acquired VTE Look Back – Hospital acquired VTE Feedback to clinical staff- process & outcome Profile the ‘at risk patient’

14. LOOK BACK – Hospital Acquired VTE

18. This look back is sent on behalf of the Outpatient Anticoagulant Service. The purpose is to give feedback to Clinicians on process and outcome, and allow us to develop a better profile of the ‘at risk’ patients. Therefore the form should NOT be placed in patients hospital notes or recorded on EMR. Signed + Clinical directors name

19. Lessons learnt so far Surgeons Physicians

20. Conclusions Need more uniformity within Trust. Thrombophylaxis in all ‘in patients’ needs to be addressed to try to reduce death rate due to VTE. Baseline assessment of the 50 clinical directorates.

21. Will ‘Look Back’ change practice? ?