Wiltshire Community Health Services
Despite VTE risk assessment in the community not being a requirement of NICE, it was felt that it was best practice, patient centred and provided seamless care for patients in our primary care trust.
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?
Aims and objectives
To give patients in the community equity of care in the reduction of their VTE risk. To risk assess patients in our community hospital wards and on our community caseloads and not be restricted by the building in which patients are cared for.
Reasons for implementing your project
This was introduced at the same time as the hospital based VTE risk assessment. As I was responsible for delivering the training it seemed strange to me as a former District Nurse that patients in the community with active cancer, who might be undergoing chemotherapy and often take to their beds due to the side effects were one of the most at risk groups but would not be assessed. This group of patients may also have life limiting disease, so it seemed that developing a VTE was the last thing they needed to reduce their lifespan even further. There was no opportunity for improving efficiency or increasing productivity but every chance to improve patient care and perhaps even preserve precious time for terminally ill patients.
How did you implement the project
After training all the ward staff, including the health care support workers so that they understood the importance of and the care of patients wearing anti-embolism stockings. I trained staff in the Neighbourhood teams including therapists as often patients are admitted to a caseload but actually only need to see a Physiotherapist or an Occupational therapist so they also needed to understand the assessment process. Initially staff were concerned that there was to be another addition to their documentation, however after the training they seemed more than happy to undertake this as they found the numbers of patients who die each year from VTE quite shocking. The only barrier was that most patients on community patients have some degree of reduced mobility and at first we thought almost everyone would have risk factors. However after discussion with Dr Tamara Everington at Salisbury District Hospital, one of the VTE exemplar sites and who were very helpful in this initiative, pointed out that patients would only be at risk if their mobility was significantly reduced relative to their normal state. As such if the patient was normally in a wheelchair this was not a risk factor as this was their normal state. This initiative was embraced by the community staff but some GPs were not happy as NICE did not require this assessment in the community and there were financial implications in funding prophylaxis in the community. This does continue to be an issue in some areas but otherwise patients' risk factors have been highlighted and decisions made as to whether mechanical or non-mechanical prophylaxis should be used.
I have been contacted by staff on an ad hoc basis for further training as now they have been assessing patients for a year they feel they need an update. Audit has only been carried out in in-patient settings but Neighbourhood team co-ordinators audit patient notes regularly and this assessment is carried out along with all the other assessments patients admitted to a community caseload have completed. The reaction and embedding of this initiative by community staff has exceeded my expectations and this is testament to their professionalism.
Key learning points
I would suggest that they consider in-patient assessment first as this is what is required by NICE. If the organisation is interested in promoting risk assessment in the community to communicate with GPs either via the medical director or through governance groups to inform them that risk factors if identified will be communicated to them for a clinical decision.
Wiltshire Community Health Services
Is the example industry-sponsored in any way?