VTE Education, Education, Education

1
VTE Education, Education, Education!

• This presentation will probably involve audience
  discussion, which will create action items. Use
  PowerPoint to keep track of these action items
  during your presentation
• In Slide Show, click on the right mouse button
• Select Meeting Minder
• Select the Action Items tab
• Type in action items as they come up
• Click OK to dismiss this box
• This will automatically create an Action Item
  slide at the end of your presentation with your
  points entered.

• J Cronin, S Majeed, E Morley-Smith, K Ganesh, S
  Ambrozie,
• M Wood, A Howard.

2
The Problem
3
Numerous Reports of Poor Prophylaxis

• Canada
• USA
• UK
• Australia NZ
• UK
• USA
• USA
• UK
• USA

• - Belch et al 1981
• - Conti Daschbach 1982
• - Jones 1991
• - Fletcher et al 1992
• - Stephens et al 1995
• - Audet et al 1998
• - Bratsler et al 1998
• - George et al 1998
• - Alizadeh Hyman 2005

4
Questionnaire Audit of Surgical Doctors Charing
Cross and Hammersmith Hospitals 2002

• Aims - Assess prescription activities of
  surgical doctors for DVT prophylaxis
• Questionnaire - 24 questions
• Response rate - 100 (n55)

Howard et al EVF 2003
5
Doctors
Howard et al EVF 2003
6
Surgical Speciality
7
Doctors Prescribing Prophylaxis
Howard et al EVF 2003
8
Source of Information
Howard et al EVF 2003
9
Uncertainty of Prophylaxis Amongst Doctors91
Howard et al EVF 2003
10
Thromboembolic Risk Assessment

• 3 Case Scenarios
• High VTE risk (n2)
• Moderate VTE risk (n1)
• 45 correct risk given
• 69 prescribed heparin stockings
• 96 approved of a single prophylaxis protocol

Howard et al EVF 2003
11
Education and Awareness Programme CXH 2002

• Lectures to all surgical HOs and SHOs
• Presentations to all surgical departments (twice)
• New hospital consensus and protocol

12
AUDIT OF CXH PROTOCOL Urology, GIT, Vascular
and Breast Surgery
(n45)
(n34)
(p0.1)
(p0.03)
(p0.003)
13
2006 Audit of Compliance With Hospital Single
Protocol

Only 60 patients 19 95 CI 14-23
n 324
14
Failure of Prophylaxis Application

• 233 patients
• Failed to receive GCS
• (72)
• 151 patients
• Failed to receive LMWH
• (47)

15
Lessons Learnt!

• Sporadic education and audit does not maintain
  compliance in VTE
• Why?
• Silent disease until its too late
• Prevention is not exciting

16
How Can The Situation Be Improved?
17
Effective Strategy

• Multifacted
• Evidence-based protocols
• Education
• Risk assessment protocol
• Computerised decision support
• Audit with feedback
• Specific staff for implementation

18
New Programme 2008Colchester Hospital University
NHS Foundation Trust

• New Trust guidelines
• Online risk assessment tool
• e-learning and education programme
• New Drug charts
• Thrombosis committee
• Audit all Trust inpatients (pre-launch
  rolling)
• Electronic alerts

19
VTE CHUFT Website
20
Laminated Handbook
21
(No Transcript)
22
Education on Risk is Complex- Online Risk
Assessment Tool

• Patient details and date of admission
• VTE risk factors
• Contraindications to prophylaxis
• Bleeding risk with LMWH
• Printed version -gt case notes

23
(No Transcript)
24
(No Transcript)
25
Education Awareness Programme

• E-learning assessment
• (http//www.elearning-essexrivers.co.uk)
• F1 and F2 teaching sessions
• Nurse patient safety teaching sessions
• Grand rounds
• Clinical governance half-days
• Electronic alerts in clinical areas

26
Education Awareness Programme

• E-learning assessment
• (http//www.elearning-essexrivers.co.uk)
• 70 pass mark
• Certificate of completion

27
Education Awareness Programme

• E-learning assessment results
• 45 completed 44 doctors, 1 nurse
• F1 23, F2 19, SpR 2
• 25/45 achieved 70 on first attempt
• 43/45 have completed (range 2-4 attempts)

28
Audication in VTE

• Audit and vascular surgical department
• 15 patients audited per week
• Immediate feedback of results on ward-rounds
• Hospital league table on intranet page/posters

29
Audication in Infection Control

• Hand Hygiene Officer
• 20 surgical patients per week
• Immediate feedback of results on ward-rounds
• Surgical league table on infection control board

30
The Clean Practice Protocol Educational Poster
31
AudicationRounds 1 3
32
Hand Washing Round 1 3
n182
33
The Next Steps
34
Patient Education

• Stop the Clot campaign
• Patient information with hospital TCI letter
• Focus Groups
• Media help

35
Maintaining Practice

• Maintenance of prophylaxis and risk assessment
  compliance
• Continued education and awareness
• Appointment of DVT Nurses for Prophylaxis and
  Treatment
• Clinical Governance sessions
• E-learning assessment study
• Improve patient education and awareness

36
Education, Education! Audication?
37
Mr Adam Howard

• Dept of Vascular and Laparoscopic Surgery
• adam.howard_at_colchesterhospital.nhs.uk
• Mobile [phone]