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									Implementing VTE Prophylaxis
within NHS Ayrshire and Arran
        Lynsey Renfrew
    VTE Programme Manager
     To reduce death and harm to patients within
    NHS Ayrshire and Arran from hospital acquired
             VTE…..how much by when?
•   Implement, promote and drive forward a VTE prevention across NHS Ayrshire and
    Arran acute services
               – Risk assessment tool
               – NHS Ayrshire and Arran care Bundle
               – Work with individual specialties
               – Data collection/evaluation tools
               – Promote current best practice
               – Training and education/patient awareness
•   Provide a coordinated approach to ensure promotion of best practice
•   Work in partnership with multidisciplinary teams to improve patient care and safety
                          PDSA Process
  Aim: Test Risk Assessment Tool (DRAFT 1) in Pre-op Assessment
               Unit and Ward 2B Crosshouse Hospital
Redesign policy to Care Bundle
format                                       Implement a VTE Risk
                                             Assessment tool and evidence
Re-design to Flowchart                       based prescribing of appropriate
Soften Language                              VTE prophylaxis within
                                             Orthopaedics NHS Ayrshire and
Eliminate review process External            Arran.
Processes looked and compared    Act     Plan resources available.
Use “opt-out” Risk Assessment

                                            Tested with elective patients by
Verbal feedback negative                    programme manager, nurses, medical
Lack of understanding of                    staff, pharmacists - 1/3/5
guidance to completing RAT       Study    Do
                                           Education about purpose and process
No Patient involvement                      Department/Stakeholder buy in
No Patient review                           Visual observation of processes,
Prescribing Issues                          process broken done each element
                                            individually tested
Poor RAT Compliance
                                            Pharmacy involvement
                           PDSA Process
         Aim: Test Risk Assessment Tool (DRAFT 2) Ward 2B
                         Crosshouse Hospital
Drug choice agreed
AES eliminated                               Implement a VTE Risk Assessment
                                             tool (DRAFT 2)and evidence based
Sign and date added to be in nursing         prescribing of appropriate VTE
profile next kardex                          prophylaxis within Orthopaedics
Recognise evidence base practice             NHS Ayrshire and Arran
                                             Ensure resources available
When and who to prescribed agreed
                                   Act     Plan

Positive feedback                            Tested with elective patients by
                                             medical staff - 1/3/5
VTEP prescribed correctly                    Re-Educate about purpose and
Compliance Increased               Study   Doprocess of opt-out risk assessment
                                             Department/Stakeholder buy in
Quicker, slicker process                     Visual observation of processes,
Flowchart easy to follow                     process broken done each element
                                             individually tested
Used as Reference document                   Pharmacy involvement
Consultants reviewed document
                 Learning Points
                 Highs and Lows
• VTE shared learning           •   No Buy In = No Success
• Learning about Improvement    •   Resistors
• Test Process/Refinement       •   PDSA method not recognised
  Process                       •   No departmental engagement
• Publicising and education     •   Knowledge deficit
  about Risk assessment
• Networking
• Developing Care Bundle,
  using this process to gain
• Positive result from
  compliance audit
• Implementing evidence based
• Sharing knowledge/practice
 VenousThromboEmbolism (VTE) Prophylaxis

                            The Bundle

All hospital in-patients are risk assessed for VTE prophylaxis.

Prophylaxis is decided and Pharmacological and/or Mechanical
  methods are prescribed correctly.

Ensure consistent review of risk assessment, changes
  documented and applied as per individual patient.

After individual review consider extended prophylaxis on
   discharge from hospital.


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