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New "Stop the clot" service in Sheffield shortlisted for top award

A new multi-disciplinary service, designed by Sheffield Teaching Hospitals NHS Trust, aims to save lives by preventing patients from developing a fatal blood clot after major abdominal and pelvic surgery for colorectal cancer. Now the “Stop the Clot” project, which puts NICE's guideline on reducing the risk of venous thromboembolism into practice, has been selected as a finalist for the 2011 NICE Shared Learning Awards.

Work on the new service began in 2010, following the development of the NICE guideline, by a team of experts, including surgeons, pharmacists, nursing staff and haematologists. Despite no extra funding or staff, the team devised a new policy to implement NICE's recommendation that appropriate postoperative patients be given a 28 day course of a blood-thinning drug to reduce the risk of blood clots.[1]

Previously patients in Sheffield received the blood-thinning drug enoxaparin only during their inpatient stay following surgery, which could be as short as three days. The new policy aimed to ensure this was extended after hospital discharge so that all patients identified as ‘at risk ‘completed a 28 day course. To achieve this, patients were trained by nursing and pharmacy staff, or local district nurses on how to self-administer the drug at home and provided with pre-loaded enoxaprin syringes and sharps bins. For those unable to administer the injection by themselves, local district nurses visited their homes to make sure the treatment course was finished.

The drugs to prevent venous thromboembolism can cause heparin-induced thrombocytopaenia (HIT), a potentially dangerous condition, in a very small number of patients. For this reason, the team produced a clear template letter to encourage local GP practices to screen their patients for HIT when using these drugs at home. This letter aimed to establish GP's understanding and support of the service.

This new policy aims to make sure no patient is put at increased risk because of bleeding or failure to promptly identify HIT, and the service is continually being audited and improved.

In the first month of the new policy's implementation, enoxaparin was successfully administered for 28 days to 12 out of 16 patients who underwent major abdominal or pelvic surgery for cancer. Compliance with HIT monitoring in the community improved during the audit period from 0 to 100 per cent.

Val Moore, NICE Implementation Director, said: "To be shortlisted for a NICE Shared Learning Awards highlights the hard work by all the team at Sheffield Teaching Hospitals NHS Trust.

"This new multidisciplinary service is a fantastic example of how to put NICE guidance into practice across local organisational boundaries to clearly benefit patients' health. A lot of valuable lessons have been learnt since the service was launched, as a result of which it is continually improving and I would like to thank the team for sharing their story with us and thereby with other organisations seeking to improve in this manner. We hope that other organisations can learn from this, and use it to inspire them to implement their own local policies to prevent patients from developing a fatal blood clot after major abdominal or pelvic cancer surgery."

Three shortlisted projects will have the opportunity to present their work at the NICE conference to be held in Birmingham on 10-11 May 2011. These presentations will be voted on by conference attendees in order to determine the overall Shared Learning Award winner.

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Notes to Editors

About the service

  • The Sheffield Teaching Hospitals NHS Foundation Trust has been shortlisted for a NICE Shared Learning Award.
  • Published in January 2010, NICE guidance on reducing the risk of venous thromboembolism recommends healthcare professionals extend pharmacological prophylaxis to 28 days postoperatively for patients who have had major cancer surgery in the abdomen or pelvis. To read the guideline in full, please visit http://www.nice.org.uk/guidance/index.jsp?action=byID&o=12695

About Shared Learning Awards

About NICE's Shared Learning Awards

  • The NICE Shared Learning Awards recognise and reward examples of how NICE guidance has been put into practice in the NHS, local authorities, voluntary and other organisations.
  • The three shortlisted projects for 2011 are:

- Statins for ischaemic heart disease: Excellence and equity - East London Clinical Effectiveness Group.

- Bringing the benefits of Home Haemodialysis Home - Central Manchester Foundation Trust.

- Stop the Clot: Implementation of extended thromboprophylaxis in patients undergoing major abdominal and pelvic cancer surgery - Sheffield Teaching Hospitals NHS Trust.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.



[1] If a blood clot forms and breaks away it may travel to the lungs and cause a blockage - a potentially fatal pulmonary embolism, or travel to the brain and cause a stroke. Prior to the publication of the NICE guideline, an estimated 25,000 people in the UK die from preventable hospital-acquired venous thromboembolism (VTE) every year (House of Commons Health Committee (2005) The prevention of venous thromboembolism in hospitalised patients. London: The Stationery Office.)

This page was last updated: 09 May 2011

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.