We have developed an electronic venous thrombo-embolism risk assessment tool which has resulted in a dramatic improvement in the numbers of patients being routinely assessed on admission to hospital and offered appropriate preventative thromboprophylaxis measures according to national guidance. The tool provides timely reminders to clinical staff, documents the risk assessment in the electronic patient record, provides guidance according to NICE recommendations and then requires confirmation that guidance has been followed (or reasons why if deviated from) for audit purposes.
University Hospitals Coventry and Warwickshire
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
To achieve the National goal of a minimum of 90% adult patients admitted to hospital undergoing an assessment of their risk of developing hospital acquired thrombosis (HAT). (1) To ensure that >90% of adults undergo a formal, documented assessment of risk of thromboembolism / bleeding on admission to hospital. (2) To provide clinical staff with guidance on the recommended thromboprophylaxis strategy relevant to the patient, according to NICE CG92. (3) To ensure that thromboprophylaxis prescriptions are in accordance with national guidance and appropriate. (4) To facilitate easy audit of performance by all clinical areas, allowing rapid identification of issues to be addressed. (5) To reduce the incidence of hospital acquired thrombosis.
Previous efforts to improve risk assessment of venous thrombo-embolism in the Trust by the Thrombosis Committee had involved widespread and systematic education and training of healthcare professionals including within the mandatory training programme; production of a paper based risk assessment tool which was distributed throughout the hospital; grand-round presentations and hospital intranet reminders. However, despite all of these, the rate of risk assessment remained fixed at around 37%. When CG92 was published in February 2010 and the subsequent national venous thrombo-embolism (VTE) prevention programme required that trusts risk assess >90% of adult patients admitted to hospital we realised that a novel solution was required.
We first attempted to identify the main reasons for non compliance: failure to remember to risk assess for venous thromboembolism when patients are admitted for unrelated conditions; lack of knowledge of the most appropriate thromboprophylaxis strategies, especially the duration of treatment. The national VTE prevention programme also required that the Trust provided a monthly census of the total number of patients risk assessed against the total number of admissions - for our hospital there are approximately 10,000 admission episodes per month. To perform this manually using paper based risk assessment forms was impractical. Therefore we quickly realised that an electronic tool which addressed each of these issues would improve compliance, hopefully resulting in fewer cases of hospital acquired VTE, and reduce the need for laborious monthly audits. Between March and May 2010 we developed an electronic tool which was incorporated into the existing pathology results system for two reasons: firstly it is the primary system used by clinical staff to look up pathology results and therefore is frequently routinely viewed during the admission process; secondly it provided us with the ability to block viewing of results until the VTE risk assessment has been completed (there is a temporary work around for emergency situations). A multi-disciplinary team was established to oversee implementation with representation from IT, Nursing, Management, Training, Communications as well as clinicians from a number of specialities. The programming was completed by the Trust IT department in May, and training completed in time for the national deadline 1st June 2010.
For the first time we were able to easily produce monthly figures of compliance with VTE risk assessment, as well as monitor prescription compliance. From our baseline of 37% risk assessments prior to implementation of the electronic tool, our compliance improved in a stepwise manner from 72% in June (our start up target was 50%) to 88% in September and since October we have consistently exceeded the 90% goal. In absolute numbers the Trust is now undertaking around 9000 electronic VTE risk assessments per month. Current monitoring has also demonstrated that prescriptions are in accordance with NICE CG92 in >90% of cases. Further work is planned to review the reasons stated for non compliance on the electronic tool to ensure they are appropriate.
An electronic VTE risk assessment and thromboprohylaxis guidance tool, based on CG92 recommendations, embedded in existing hospital pathology results systems provides a practical solution for improving performance in this challenging area.
University Hospitals Coventry and Warwickshire
Is the example industry-sponsored in any way?