VTE Education, Education, Education!

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VTE Education, Education, Education!

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

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The Problem
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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

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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
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Doctors
Howard et al EVF 2003
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Surgical Speciality
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Doctors Prescribing Prophylaxis
Howard et al EVF 2003
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Source of Information
Howard et al EVF 2003
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Uncertainty of Prophylaxis Amongst Doctors91
Howard et al EVF 2003
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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
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Education and Awareness Programme CXH 2002

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

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

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

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

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Lessons Learnt!

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

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How Can The Situation Be Improved?
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Effective Strategy

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

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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

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VTE CHUFT Website
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Laminated Handbook
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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

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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

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Education Awareness Programme

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

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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)

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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

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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

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The Clean Practice Protocol Educational Poster
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AudicationRounds 1 3
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Hand Washing Round 1 3
n182
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The Next Steps
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Patient Education

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

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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

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Education, Education! Audication?
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Mr Adam Howard

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