Northern Health - Acute Services Evidence Based Practice Venous Thromboembolism Prevention (VTE) Jeannette Kamar Christine Lamotte, Liam Carter Improving Patient Safety Preventing and Managing Venous Thromboembolism 29-30 March 2012, Melbourne 30/03/2012 1 1
Northern Health (NH) Five Sites - Northern Suburbs of Melbourne 30/03/2012 2 2
The Northern Hospital (TNH) Acute Public Hospital in Melbourne 370 beds 30/03/2012 3 3
Outline Overview of our Journey Initiatives / Barriers / Enablers Current Tools Results 30/03/2012 4 4
2003 TNH identified VTE as a Clinical Risk Formed Steering Committee Introduced Risk Assessment - Completed by Nursing Staff VTE Prophylaxis Prescribed - By Medical Staff 30/03/2012 5 5
2004 Medical Staff continued to prescribe according to own knowledge and preference Barriers: Nursing Staff completing Risk Assessment Limited education for Medical Staff No Best Practice Guidelines used No Audits / feedback of progress 30/03/2012 6 6
2005 VTE still a Clinical Risk NH joint NICS VTE Project Received financial assistance for 12 months from Victorian Quality Council in 2006 30/03/2012 7 7
2006 Baseline Audit: - 44% Optimal Prophylaxis Prescribed (High Risk patients) Aim: - 90% of Acute General Ward Inpatients to receive optimal Prophylaxis as per Best Practice Guidelines 30/03/2012 8 8
Feb 2006 Appointed VTE Coordinator Re-invigorated Committee Multidisciplinary Head of Departments Medicine, Surgery, Anaesthetics, Pharmacy, Nursing, Clinical Risk, Health Information Enablers: Coordinator to drive the project Senior staff on Committee: decisions made were easy to implement 30/03/2012 9 9
Feb Aug 2006 New Risk Assessment Tool Based on Best Practice Printed as extra page on National Medication Chart Staff Education: Medical Staff: 1 to 1 by Pharmacist Nursing Staff: hospital-wide 30/03/2012 10 10
Sept Nov 2006 Risk Tool Introduced: early Sept 06 Audit late Sept 74% Optimal Prophylaxis Intern Rotation: early Nov 06 Audit late Nov 52% Optimal Prophylaxis 30/03/2012 11 11
November 2006 Barriers: Focus of education should have been on Medical not Nursing Staff No education & evidence of Best Practice presented to senior Medical Staff No ongoing education program 30/03/2012 12 12
Nov 2006 March 2007 Senior Medical Staff: Education by Expert Audit data feedback by Treating Units Junior Medical Staff: Ongoing education at each rotation Patient Education Audit March 2007 72% Optimal Prophylaxis 30/03/2012 13 13
March - August 2007 VTE: Standard agenda item at Clinical Risk meetings (Report to the Board) Added Prescribing Box On Medication Chart under Regular Medication Audit August 2007 98% Optimal Prophylaxis 30/03/2012 14 14
Summary of Enablers Committee with Head of Departments Consultant Support Risk Assessment and Prescribing of Prophylaxis conducted by Medical Staff Risk Tool and Prescribing Box on Medication Chart Education for Medical Staff» Nursing staff awareness of the process 30/03/2012 15 15
November 2007 30/03/2012 16 16
Prophylaxis Prescribed Point Prevalence Audits VTE Prophylaxis Prescribed % of High Risk Patients with Optimal Prophylaxis 100% 98% 97% 95% 96% 98% 75% 50% 44% 71% 74% 52% 72% 25% 0% Feb-06 May-06 Sep-06 Nov-06 Mar-07 Aug o7 Dec-07 Nov-08 Nov-09 Dec-11 Maintained Aim of 90% 30/03/2012 17 17
Documentation of Risk Level Point Prevalence Audits: Details Documented in VTE Prophylaxis Prescribing Box on Medication Chart % Prohpylaxis % Patient Risk Level 120 100 91 95 99 97 100 80 60 40 20 0 13 0 3 4 2 Aug o7 Dec-07 Nov-08 Nov-09 Dec-11 Minimal support to improve documentation of patient s Risk Level: No perceived benefits 30/03/2012 18 18
2010 Orthopaedic Patients New Senior Orthopaedic Staff raised concerns regarding benefits of VTE chemical prophylaxis versus bleeding risks Optimal prophylaxis (in line with NHMRC guideline) among Ortho inpatients reduced to 38% Extensive Consultation over 12 months period Introduction of Foot-pumps Agreed upon procedures 30/03/2012 19 19
2011 - Policy & Procedures - Existing VTE Policy - Agreed upon; Associated Ortho Procedures 30/03/2012 20 20
NH Acute Ortho Inpatient Procedures 30/03/2012 21 21
NH Acute Ortho Inpatient Procedures 30/03/2012 22 22
Ortho Inpatients Prescribed Prophylaxis Point Prevalence Audits Orthopaedic Inpatients % VTE Prophylaxis Prescibed as per NH Policy 100% 96% 100% 75% 50% 41% 38% 25% 0% Nov- 09 Dec- 09 Jan- 10 Feb- 10 Mar- 10 Apr- 10 May- 10 Jun- 10 Jul-10 Aug- 10 Sep- 10 Oct- 10 30/03/2012 23 23
2012 - NH Medication Chart FRONT PAGE 30/03/2012 24 24
2012 - NH Medication Chart INSIDE 30/03/2012 25 25
2012 - NH Medication Chart 30/03/2012 26 26
2012 - NH Medication Chart BACK PAGE 30/03/2012 27 27
Sustainability Systems to consistently prescribe VTE prophylaxis inline with Best Practice Guidelines integrated into daily practice VTE Education for Medical Staff: Included in e-learning package for new staff Part of Orientation Program for Interns Using Case Studies / Tools on the medication chart VTE Project has been integrated with other Injury Prevention projects to ensure sustainability 30/03/2012 28 28
Northern Health - Acute Services Evidence Based Practice Venous Thromboembolism Prevention (VTE) Jeannette Kamar Christine Lamotte, Liam Carter Injury Prevention Unit The Northern Hospital - Northern Health 185 Cooper Street, Epping, Vic, Australia, 3076. Phone: (03) 8405 8095 30/03/2012 29 Email: Jeanette.Kamar@nh.org.au 29