anne blumgart principal pharmacist due improvement science professional development program venous...
TRANSCRIPT
Anne Blumgart Principal Pharmacist DUE
Improvement Science Professional Development Program
Venous Thromboembolism (VTE) Prevention in Ward 9
Content and AimAimTo increase the percentage of adult inpatients being VTE risk-assessed within 24 hours of admission (from 3%) to 90% by the end of July 2013.
System Systems-based approach to achieving whole-of-hospital VTE prevention programme, including routine, documented VTE risk assessment for all admitted adult patients to guide appropriate VTE prevention.
Guidance • Identification of ‘the problem’ and current status quo• Review of best evidence• International best practice - NHS South West VTE Exemplar Sites, Global VTE Prevention Forum - UK, USA, Canada, Japan, Australia, Germany, New Zealand• National Policy Framework: VTE Prevention in Adult Hospitalised Patients in NZ• ISIA methodology for ward 9 pilot
Constraints1. Technological2. Financial3. Clinical opinion
Name ofMeasure
Is this an Outcome, Process or Balancing
Measure?
Operational Definition (e.g., numerator &
denominator)% compliance with VTE risk assessment within 24 hours of admission
Process Numerator: No. of admitted adult patients (LOS ≥ 24 hrs) VTE risk assessed within 24 hours of admission
Denominator: No. of adult patients hospitalised for ≥ 24 hours
% of at-risk adult hospitalised patients with a LOS ≥ 24 hours receiving appropriate VTE prophylaxis within 24 hours of admission
Process Numerator: No. of admitted adult patients requiring VTE prophylaxis who receive it as per CMH guidelines
Denominator: Total no. of admitted adult adult patients who are appropriate candidates for VTE prophylaxis
Measures
Name ofMeasure
Is this an Outcome, Process or Balancing
Measure?
Operational Definition (e.g., numerator &
denominator)Number of admitted adult patients with a LOS ≥ 24 hours who develop a VTE event, (specifically, proximal lower extremity DVT / PE), during hospitalisation, or within 90 days of discharge
Outcome Numerator: No. of adult patients who develop confirmed proximal lower extremity DVT / PE during hospitalisation, or who are readmitted within 90 days of discharge with proximal lower extremity DVT / PE.
Denominator: Total no. of patient-days (for the month being audited) for adult hospitalised patients with LOS > 24 hours
% of adult hospitalised patients who receive pharmacological VTE prophylaxis who experience an anticoagulation-related bleeding event.
Balancing Numerator: No. of adult hospitalised patients who experience a bleeding event related to pharmacological VTE prophylaxis.
Denominator: Total no. of admitted adult patients receiving pharmacological VTE prophylaxis
Measures
Change Concepts & Ideas for PDSAs
Idea for Testing in a PDSA
Theory and prediction about what will happen when you test this idea
Red reminder stickers in clinical notes and on the VTE
prevention section of the medication chart
Prompt to spur action – increased awareness and compliance with risk assessment process
Large VTE risk assessment reminder and information card
placed in medication chart
Process prompt and specific information on VTE risk assessment process - increased knowledge and compliance with process
Detailing of new house officers on the ward
Relationship building to increase house officer knowledge of processes and expectations, and increase cooperation - increased knowledge and compliance with process
VTE Prevention eModule Increased knowledge and understanding of VTE/bleeding risk, processes and clinical management of prevention - increased knowledge and understanding resulting in improved VTE prevention management
Results of your PDSAs
VTE risk assessment reminder stickers introduced
Holiday period VTE risk assessment reminder card inserted in medication chart
House officer rotation
House officers settling in
Target 90% +
8
Profound Knowledge Worksheet
Appreciation for a System• Busy clinical environment• Clinician workflow• Processes• Culture• Clinical opinion• Prompts / reminders
Psychology• Staff behaviour• Role-modeling• Fear / lack of confidence• Habit• ‘Work-arounds’
Theory of Knowledge• Change management• Teaching and learning• Data / statistics • Population Health• Best evidence / best practice
Understanding Variation • Seasonal effects • House officer rotations• Staff shortages / changes• Busyness• Prioritisation
Process Changes and Results
• VTE Prevention-related activity as part of PGY1 ‘The Amazing Race’ orientation:─ PGY1s aware of VTE risk assessment process - baseline 3%
• Routine, documented VTE risk assessment process - reminders / prompts / one-on-one and group detailing and encouragement: ─ 65% documented VTE risk assessment process in ward 9
• Printed & verbal patient information routinely provided to patients─ Impact to be assessed
• VTE Prevention eModule - routine completion as part of induction training─ Impact to be assessed
• Newly introduced CMH VTE Prevention Policy─ Impact to be assessed
What next?
• CMH VTE Prevention Policy
• VTE Prevention eModule routinely included in house induction training
• VTE Prevention Week 29th April - 3rd May
• Routine house officer teaching
• Further roll-out of CMH VTE Prevention Programme NHS East
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