VTE Education Education Colchester Hospital University NHS Foundation

VTE Education, Education! Colchester Hospital University NHS Foundation Trust J Cronin, S Majeed, E Morley-Smith, K Ganesh, S Ambrozie, M Wood, A Howard.

Numerous Reports of Poor Prophylaxis • • • Canada USA UK Australia & NZ UK USA - Belch et al 1981 - Conti & Daschbach 1982 - Jones 1991 - Fletcher et al 1992 - Stephens et al 1995 - Audet et al 1998 - Bratsler et al 1998 - George et al 1998 - Alizadeh & Hyman 2005

Questionnaire Audit of Surgical Doctors Charing Cross and Hammersmith Hospitals 2002 • Aims - Assess prescription activities of surgical doctors for DVT prophylaxis • Questionnaire - 24 questions • Response rate - 100% (n=55) Howard et al EVF 2003

Doctors Howard et al EVF 2003

Surgical Speciality

Doctors Prescribing Prophylaxis Howard et al EVF 2003

Source of Information Howard et al EVF 2003

Uncertainty of Prophylaxis Amongst Doctors 91% Howard et al EVF 2003

Thromboembolic Risk Assessment • 3 Case Scenarios – High VTE risk (n=2) – Moderate VTE risk (n=1) • 45% correct risk given • 69% prescribed heparin & stockings • 96% approved of a single prophylaxis protocol Howard et al EVF 2003

Education and Awareness Programme CXH 2002 • Lectures to all surgical HO’s and SHO’s • Presentations to all surgical departments (twice) • New hospital consensus and protocol

AUDIT OF CXH PROTOCOL Urology, GIT, Vascular and Breast Surgery (n=45) (p=0. 1) (p=0. 03) (n=34) (p=0. 003)

2006 Audit of Compliance With Hospital Single Protocol Only 60 patients = 19% [95% CI 14 -23%] n = 324

Failure of Prophylaxis Application 233 patients Failed to receive GCS (72%) 151 patients Failed to receive LMWH (47%)

Lessons Learnt! Sporadic education and audit does not maintain compliance in VTE Why? Silent disease until its too late Prevention is not exciting

Effective Strategy • • Multifacted Evidence-based protocols Education Risk assessment protocol Computerised decision support Audit with feedback Specific staff for implementation

New Programme 2008 Colchester Hospital University NHS Foundation Trust ü New Trust guidelines ü Online risk assessment tool ü e-learning and education programme ü New Drug charts ü Thrombosis committee ü Audit all Trust inpatients (pre-launch & ‘rolling’) Ø Electronic alerts

VTE CHUFT Website

Laminated Handbook

Education on Risk is Complex - Online Risk Assessment Tool • Patient details and date of admission • VTE risk factors • Contraindications to prophylaxis • Bleeding risk with LMWH • Printed version -> case notes

Education & Awareness Programme ü E-learning assessment (http: //www. elearning-essexrivers. co. uk) ü F 1 and F 2 teaching sessions ü Nurse patient safety teaching sessions ü Grand rounds ü Clinical governance half-days Ø Electronic alerts in clinical areas

Education & Awareness Programme • E-learning assessment (http: //www. elearningessexrivers. co. uk) • 70% pass mark • Certificate of completion

Education & Awareness Programme E-learning assessment results • 45 completed – 44 doctors, 1 nurse • F 1= 23, F 2= 19, Sp. R = 2 • 25/45 achieved 70% on first attempt • 43/45 have completed (range 2 -4 attempts)

‘Audication’ in VTE • Audit and vascular surgical department • 15 patients audited per week • Immediate feedback of results on wardrounds • Hospital league table on intranet page/posters

‘Audication’ in Infection Control • Hand Hygiene Officer • 20+ surgical patients per week • Immediate feedback of results on wardrounds • Surgical league table on infection control board

The Clean Practice Protocol Educational Poster

‘Audication’ Rounds 1 & 3

Hand Washing Round 1 & 3 n=182

Patient Education • ‘Stop the Clot’ campaign • Patient information with hospital TCI letter • Focus Groups • Media help

Maintaining Practice Ø Maintenance of prophylaxis and risk assessment compliance • Continued education and awareness • Appointment of DVT Nurses for Prophylaxis and Treatment • Clinical Governance sessions Ø E-learning assessment study Ø Improve patient education and awareness

Mr Adam Howard Dept of Vascular and Laparoscopic Surgery adam. howard@colchesterhospital. nhs. uk Mobile 07507646586