The NIMC VTE Pilot How to use the NIMC VTE prophylaxis section Frequently asked questions Extent of issue In 2008 VTE cases 14716 Deaths 5285 Working age 43 Total inpatient costs 812m ID: 760619
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Slide1
Slide2Slide 2 of n
Overview
The burden of VTE in Australia
The NIMC VTE Pilot
How to use the NIMC VTE prophylaxis section
Frequently asked questions
Slide3Extent of issue
In 2008:
VTE cases 14,716
Deaths 5,285
Working age 43%
Total inpatient costs $81.2m
Slide4Comparison of deaths
Reference:
1. Access Economics Pty Limited (2008) The burden of venous thromboembolism in Australia. Report for the Australian and New
Zealand Working Party on the Management and Prevention of Venous Thromboembolism.
https://www.deloitteaccesseconomics.com.au/uploads/File/The%20burden%20of%20VTE%20in%20Australia.pdf.
Accessed 1 June 2013.
Slide5Australian Safety and Quality Goals for Health Care
Goal 1 Safety of care:
That people receive their health care without experiencing preventable harmOutcome 1.1.3: Adults experience fewer venous thromboembolisms associated with hospitalisation.There is strong evidence that appropriate risk assessment and prophylaxis can reduce the risk and incidence of venous thromboembolism.
www.safetyandquality.gov.au/wp-content/uploads/2012/08/Goal-1.1-Medication-Safety-Action-Guide-PDF-486KB.pdf
Slide6NIMC VTE Pilot
National piloting of a pilot NIMC with VTE section was undertaken in two phases beginning in August 2010 and finishing in December 2012
Over 30 hospitals from five states participated in the pilots
The results provided strong support for inclusion of a VTE prophylaxis section in a new version of the NIMC
Slide7NIMC VTE Pilot Results:Quantitative Audit Results
Audit Parameter (% patients)
Phase 1
Pre-Audit
Phase 1
Post-Audit
Phase 2
Pre-Audit
Phase 2
Post-Audit
Documentation of VTE risk assessment
9.4%
17.2%
35.9%
57.2%
Documentation of VTE risk assessment in VTE section
0%
17.2%
0%
44.7%
VTE prophylaxis prescribed (mechanical and/or pharmacological)
58.1%
65.6%
65.2%
69.3%
Pharmacological
VTE prophylaxis prescribed
55.1%
62.4%
59.4%
64.4%
Pharmacological
VTE prophylaxis prescribed in the VTE section
n.c
66%
n.c
78.6%
Mechanical VTE prophylaxis ordered
18.6%.
19.2%
33.6%
32.3%
Slide8NIMC VTE Pilot Results:Safety features and administration errors (raw numbers)
Audit ParameterPhase 1 Pre-AuditPhase 1Post-AuditPhase 2 Pre-AuditPhase 2Post-AuditAverage charts per patient1.541.511.561.56Patients with pharmacological VTE prophylaxis prescribed in VTE and regular meds sectionn.c24n.c2Patients with active orders for both pharmacological VTE prophylaxis and therapeutic anticoagulant 2329n.c2Pharmacological VTE prophylaxis ordered when contraindicatedn.c1584Mechanical VTE prophylaxis ordered when contraindicatedn.c.n.c32% anticoagulant doses documented as given87.1%87.3%95.6%96.4%% checks mechanical prophylaxis documented74.0%43.0%75.1%68.9%
n.c = not collected
Slide9NIMC VTE Phase 2 Pilot Results:Mechanical VTE prophylaxis documentation
Slide10NIMC VTE Pilot Study conclusions
Introduction of a VTE section across a range of hospitals significantly
increased
rates of VTE risk assessment documentation and VTE prophylaxis prescribing while
not increasing
the risk of duplicate anticoagulant therapy being prescribed
VTE section
did not increase
the number of active medication charts per patient nor increase the risks associated with multiple charts
Slide11NIMC VTE Pilot Study conclusions
VTE prophylaxis section on the NIMC only one part of a hospital-wide VTE prevention policy
Other essential components include:
Senior executive and clinician support
Explicit policies for VTE prevention
Sufficient resources for education/implementation
Education on conducting a VTE risk assessment
Instruction on correct use of the VTE section
Slide12How to use the
NIMC VTE prophylaxis section
Slide13Slide 13 of n
The VTE section has been placed above the warfarin section to assist with the recognition of patients who are already receiving therapeutic anticoagulation and do not require additional VTE prophylaxis
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VTE prophylaxis section: How it works
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Step 1: Document patient’s VTE risk assessment
Authorised clinician:Determines patient’s risk for VTE (as per local policy) Assesses patient’s risk of bleeding/contraindications to VTE prophylaxis vs. benefits of VTE prophylaxis and formulates overall risk assessmentDocuments if VTE prophylaxis NOT required/contraindicated by ticking the appropriate box* Documents assessment is complete by ticking the VTE risk assessed box and signing and dating in the field provided
*
Specific contraindications to VTE prophylaxis should be documented in the medical record
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Step 2: Order pharmacological VTE prophylaxis
Prescriber selects an appropriate agent if indicated Choice of agent depends on patient’s VTE risk level (See hospital policy or NHMRC clinical practice guideline for VTE prevention)Specify route, dose, frequency & administration timesNurse initials the administration of medication
Order pharmacological prophylaxis if indicated: medication, route, dose and frequency
Document administration of medication
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Step 3: Order mechanical VTE prophylaxis
Authorised clinician orders mechanical prophylaxis where appropriate (e.g. graduated compression stockings, foot pump)Authorised personnel - a nurse or a doctor, as per hospital policy Nurse signs when mechanical prophylaxis checked
Order mechanical prophylaxis if required
Document mechanical prophylaxis checked
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Frequently asked questions
Q: How do I order mechanical VTE prophylaxis on the NIMC?A: In the space in the VTE section titled ‘Mechanical prophylaxis’ write in the type of mechanical prophylaxis being used e.g. TEDS, GCS, IPC etc. Sign, print your name and your contact details e.g. pager number
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Frequently asked questions (cont.)
Q: What does documenting mechanical prophylaxis checks on the VTE section mean?
A: The hospital’s policy on VTE prophylaxis should include regular monitoring of mechanical prophylaxis to ensure correct application. This varies by hospital but can include checks for skin integrity (colour, warmth, pulse, pressure area etc) and that stockings are being worn. This is usually done morning and evening and the responsible clinician should sign their initials in the space provided when the check has been satisfactorily completed.
Slide20Slide 20 of n
Frequently asked questions (cont.)
Q: What should I do if VTE prophylaxis is contraindicated?A: Complete the risk assessment section indicating that VTE prophylaxis is contraindicated and cross out the relevant ordering section (pharmacological and/or mechanical). The prescriber should also write “contraindicated” and sign in the administration section.
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Frequently asked questions (cont.)
Q: What should I do if the VTE prophylaxis ordered needs to be changed?
A:
If the dose of VTE prophylaxis medicine needs to be changed, a new order should be prescribed on a subsequent chart.
Q: Where should VTE treatment be ordered on the chart?
A:
If VTE therapy is required e.g. for a pre-existing DVT, it should be ordered in the regular medicines space and
not
in the pre-printed VTE prophylaxis section.
Slide22Slide 22 of n
Contact details:
<< Hospital name >>
Ph
: << 0000 0000 pager XXXX >>
Email: <<add
email address
>>