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Venous thromboembolism: reducing the risk: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital [CG92]

Measuring the use of this guidance

Recommendation: 1.1.1

Assess all patients on admission to identify those who are at increased risk of VTE.

What was measured: Patients assessed on admission for VTE risk

Data collection end: November 2009

6.9%

Number that met the criteria: 16 / 232

Data collection end: January 2010

18.52%

Number that met the criteria: 40 / 216

Data collection end: April 2010

19.61%

Number that met the criteria: 40 / 204

Data collection end: April 2011

98.66%

Number that met the criteria: 221 / 224

Area covered:	Local
Source:	Basey AJ et al. (2012). Challenges in implementing government-directed VTE guidance for medical patients: a mixed methods study. BMJ open, 2.6

What was measured: Patients assessed on admission for VTE risk

Data collection end: October 2009

51.5%

Data collection end: October 2010

79.2%

Area covered:	Multi-region
Source:	Child S et al (2014) Has incentive payment improved venous thrombo-embolism risk assessment and treatment of hospital in-patients? F1000Research Vol, 41 (doi: 10.12688/f1000research.2-41.v1)

What was measured: Proportion of reported patients who had a new venous thromboembolism.

Data collection end: May 2012

Data collection end: May 2013

0.6%

Data collection end: May 2014

0.4%

Data collection end: May 2015

0.4%

Data collection end: May 2016

0.4%

Area covered:	England
Source:	NHS Digital. NHS Safety Thermometer: Patient Harms and Harm Free Care

What was measured: Proportion of patients who had lower leg surgery or trauma and were risk assessed for VTE.

Data collection end: May 2013

66.6%

Area covered:	Local
Source:	True, V.L.W (2014) Do patients receive the appropriate assessment and implementation of venous thromboembolism prophylaxis for lower leg trauma and surgery? British Journal of Haematology

What was measured: Proportion of patients who were assessed on admission to identify those who are at increased risk of VTE.

Data collection end: November 2013

52%

Number that met the criteria: 23 / 44

Data collection end: March 2014

93%

Number that met the criteria: 39 / 42

Area covered:	Local
Source:	Gerakopoulos, E. (2015) Improving venous thromboembolism (VTE) prophylaxis in acute urological admissions during out of hours through the introduction of a urological admission proforma. BMJ Quality Improvement Reports, vol. 4, issue 1.

What was measured: Proportion of patients who were assessed on admission to identify those who are at increased risk of VTE.

Data collection end: September 2014

92%

Number that met the criteria: 39 / 43

Area covered:	Local
Source:	Gerakopoulos, E. (2015) Improving venous thromboembolism (VTE) prophylaxis in acute urological admissions during out of hours through the introduction of a urological admission proforma. BMJ Quality Improvement Reports, vol. 4, issue 1.

What was measured: Proportion of adult hospital admissions assessed for risk of VTE on admission.

Data collection end: March 2016

96%

Area covered:	England
Source:	NHS England VTE Risk Assessment Data Collection

Recommendation: 1.4.1

Offer pharmacological VTE prophylaxis to general medical patients assessed to be at increased risk of VTE (see section 1.1). Choose any one of: fondaparinux sodium low molecular weight heparin (LMWH) unfractionated heparin (UFH) (for patients with renal failure). Start pharmacological VTE prophylaxis as soon as possible after risk assessment has been completed. Continue until the patient is no longer at increased risk of VTE.

What was measured: Patients who required LMWH who had LMWH prescribed appropriately

Data collection end: November 2009

49.66%

Number that met the criteria: 73 / 147

Data collection end: January 2010

61.74%

Number that met the criteria: 71 / 115

Data collection end: April 2010

67.83%

Number that met the criteria: 78 / 115

Data collection end: April 2011

92.65%

Number that met the criteria: 126 / 136

Area covered:	Local
Source:	Basey AJ et al. (2012). Challenges in implementing government-directed VTE guidance for medical patients: a mixed methods study. BMJ open, 2.6

Recommendation: 1.5.7

Offer VTE prophylaxis to patients undergoing bariatric surgery. • Start mechanical VTE prophylaxis at admission. Choose any one of: - anti-embolism stockings (thigh or knee length) - foot impulse devices - intermittent pneumatic compression devices (thigh or knee length). • Continue mechanical VTE prophylaxis until the patient no longer has significantly reduced mobility

What was measured: In units that perform bariatric surgery -availability of appropriately sized anti-embolism stockings for morbidly obese patients

Data collection end: August 2010

90.5%

Number that met the criteria: 95 / 105

Area covered:	National
Source:	NCEPOD - Bariatric Surgery: Too Lean a Service?

Recommendation: 1.5.9

Offer VTE prophylaxis to patients undergoing gynaecological, thoracic or urological surgery who are assessed to be at increased risk of VTE (see section 1.1). Start mechanical VTE prophylaxis at admission. Choose any one of: anti‑embolism stockings (thigh or knee length) foot impulse devices intermittent pneumatic compression devices (thigh or knee length). Continue mechanical VTE prophylaxis until the patient no longer has significantly reduced mobility. Add pharmacological VTE prophylaxis for patients who have a low risk of major bleeding, taking into account individual patient factors and according to clinical judgement. Choose one of: LMWH UFH (for patients with severe renal impairment or established renal failure). Continue pharmacological VTE prophylaxis until the patient no longer has significantly reduced mobility (generally 5–7 days)

What was measured: Proportion of pelvic cancer centres that reported using both low molecular weight heparin and anti-DVT stockings during the inpatient period after radical cystectomy.

Data collection end: January 2013

100%

Number that met the criteria: 61 / 61

Area covered:	UK
Source:	Pridgeon S.Allchorne. (2014) Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: A UK national audit, BJU International, Vol 115, Issue 2, pp 223-229

What was measured: Proportion of pelvic cancer centres that reported using anti-DVT stockings during the inpatient period after radical prostectomy.

Data collection end: January 2013

100%

Number that met the criteria: 64 / 64

Area covered:	UK
Source:	Pridgeon S.Allchorne. (2014) Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: A UK national audit, BJU International, Vol 115, Issue 2, pp 223-229

What was measured: Proportion of pelvic cancer centres that reported using low molecular weight heparin during the inpatient period after radical prostectomy.

Data collection end: January 2013

98%

Number that met the criteria: 63 / 64

Area covered:	UK
Source:	Pridgeon S.Allchorne. (2014) Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: A UK national audit, BJU International, Vol 115, Issue 2, pp 223-229

Recommendation: 1.5.10

Extend pharmacological VTE prophylaxis to 28 days postoperatively for patients who have had major cancer surgery in the abdomen or pelvis.

What was measured: Proportion of pelvic cancer centres that reported always using low molecular weight heparin post discharge for radical cystectomy.

Data collection end: January 2013

67%

Number that met the criteria: 41 / 61

Area covered:	UK
Source:	Pridgeon S.Allchorne. (2014) Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: A UK national audit, BJU International, Vol 115, Issue 2, pp 223-229

What was measured: Proportion of pelvic cancer centres that reported always using low molecular weight heparin post discharge for radical prostectomy.

Data collection end: January 2013

61%

Number that met the criteria: 39 / 64

Area covered:	UK
Source:	Pridgeon S.Allchorne. (2014) Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: A UK national audit, BJU International, Vol 115, Issue 2, pp 223-229

Recommendation: 1.6.3

Consider offering pharmacological VTE prophylaxis to patients with lower limb plaster casts after evaluating the risks (see section 1.1) and benefits based on clinical discussion with the patient. Offer LMWH (or UFH for patients with severe renal impairment or established renal failure) until lower limb plaster cast removal. [2010]

What was measured: Percentage where a VTE risk assessment was carried out in the emergency department prior to discharge.

Data collection end: March 2016

25.9%

Area covered:	UK
Source:	Royal College of Emergency Medicine. VTE Risk in Lower Limb Immobilisation in Plaster Cast.

What was measured: Percentage of patients who were provided with a information leaflet on the risk of VTE, symptoms and where to seek medical help.

Data collection end: March 2016

13.3%

Area covered:	UK
Source:	Royal College of Emergency Medicine. VTE Risk in Lower Limb Immobilisation in Plaster Cast.

Recommendation: 1.7.2

Before starting VTE prophylaxis, offer patients and/or their families or carers verbal and written information on: the risks and possible consequences of VTE the importance of VTE prophylaxis and its possible side effects the correct use of VTE prophylaxis (for example, anti‑embolism stockings, foot impulse or intermittent pneumatic compression devices). how patients can reduce their risk of VTE (such as keeping well hydrated and, if possible, exercising and becoming more mobile). [2010]

What was measured: Proportion of Trusts that produce and disseminate their own patient information leaflets on VTE prevention.

Data collection end: March 2016

77%

Area covered:	National
Source:	All Party Parliamentary Thrombosis Group Report

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