Quality standard

Quality statement 2: Venous thromboembolism risk assessment for people with lower limb immobilisation

Quality statement

People aged 16 and over who are discharged with lower limb immobilisation are assessed to identify their risk of venous thromboembolism (VTE). [new 2021]

Rationale

A significant number of people are discharged after hospital treatment for trauma or orthopaedic surgery with temporary lower limb immobilisation. These people may have an increased risk of VTE, but may not have their VTE risk assessed if they are treated in the emergency department or as outpatients. Ensuring that they have a risk assessment will enable them to have VTE prophylaxis if needed and reduce their risk of VTE and mortality. It is also an opportunity to explain the risks of VTE from immobilisation to them.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of written clinical protocols to ensure that people aged 16 and over who are discharged with lower limb immobilisation are assessed to identify their risk of VTE.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from service protocols.

Process

Proportion of people aged 16 and over who are discharged with lower limb immobilisation who are assessed to identify their risk of VTE.

Numerator – the number in the denominator who are assessed to identify their risk of VTE.

Denominator – the number of people aged 16 and over who are discharged with lower limb immobilisation.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Rates of thrombosis.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (secondary care services, such as orthopaedic departments, fracture clinics and emergency departments) ensure that written clinical protocols are in place so that people aged 16 and over who are discharged with lower limb immobilisation are assessed to identify their risk of VTE and to decide whether they need pharmacological VTE prophylaxis. They also have protocols on giving verbal and written information to people and their family members or carers about the signs and symptoms of VTE, how to reduce their risk of VTE and how to seek help if VTE is suspected, as well as the benefits and possible side effects of pharmacological VTE prophylaxis.

Healthcare professionals (such as doctors, allied health professionals, trauma teams and orthopaedic specialists) carry out a risk assessment for people aged 16 and over who are discharged with lower limb immobilisation to identify their risk of VTE and decide whether they need pharmacological VTE prophylaxis. They discuss the outcome of the assessment with the person and involve them in making decisions about pharmacological VTE prophylaxis if it is needed. They also give verbal and written information to people and their family members or carers about the signs and symptoms of VTE, how to reduce their risk of VTE and how to seek help if VTE is suspected, as well as the benefits and possible side effects of pharmacological VTE prophylaxis.

Commissioners (clinical commissioning groups) ensure that services have written clinical protocols in place so that people aged 16 and over who are discharged with lower limb immobilisation are assessed to identify their risk of VTE and to decide whether they need pharmacological VTE prophylaxis. They also ensure they have protocols on giving verbal and written information to people and their family members or carers about the signs and symptoms of VTE, how to reduce their risk of VTE and how to seek help if VTE is suspected, as well as the benefits and possible side effects of pharmacological VTE prophylaxis.

People aged 16 and over who have a limb that is affected in a way that means they are unable to bear weight on it when they are sent home from hospital (for example, with a leg in a plaster cast or splint) have an assessment to check whether they need to take medicine temporarily (until they can move their leg normally again) to prevent a blood clot developing. They discuss the result of the assessment with a healthcare professional and make decisions about taking the medicine if it is needed. Their healthcare professional explains and gives them written information about the signs and symptoms of blood clots, how to reduce their risk of getting a blood clot and what to do if they think they have one, as well as the benefits and possible side effects of medicine to prevent blood clots.

Definitions of terms used in this quality statement

Discharged with lower limb immobilisation

Discharged from the emergency department or from outpatient treatment with any clinical decision taken to temporarily manage the affected limb in a way that would prevent normal weight-bearing status or use of that limb, or both.

[Adapted from NICE's guideline on venous thromboembolism in over 16s, terms used in this guideline and expert opinion]

Equality and diversity considerations

Statement 2 highlights that people are given verbal and written information on the signs and symptoms of venous thromboembolism (VTE), how to reduce their risk of VTE and how to seek help if VTE is suspected. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. For people with additional needs related to a disability, impairment or sensory loss, information should also be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.