Peter DaviesSenior Pharmacist

Venous thromboembolic prevention is a DH patient safety priority

NICE clinical guideline venous thromboembolism reducing the risk

CQUIN

The NHS standard contract for acute services and VTE prevention

VTE risk assessment audit

Clinical incident/Pharmacy intervention monitoring

Healthcare record audit

Root cause analysis of hospital acquired thrombosis

Rivaroxaban use in elective THR and TKR

Audit data since June 2008

Data collected from the front of the drug administration and record chart

3 monthly data until May 2010 now monthly

CQUIN requirements

Reporting forms adapted to include fields to record incidents and interventions relating to VTE prevention and prophylaxis

Report generated by clinical risk and sent monthly to the thrombosis committee

Data provided by individual wards

Audit of 5 sets of healthcare records

Record data on whether risk assessment and thromboprophylaxis is appropriate on an electronic data collection form

Data collated by clinical audit and forwarded to the Thrombosis committee

Hospital acquired thrombosis detected by

DVT/Anticoagulant clinic Coding Diagnostics Autopsies

Subjected to a root cause analysis

Reviewed by the Thrombosis committee

For elective Primary THR or TKR

First dose 30 hours post surgery

14 days for TKR and 35 days for THR

Contra-indicated e-GFR <30ml/min

Not used if on long term anticoagulant

Documented bleeding episodes resulting in rivaroxaban being stopped/omitted

Number ofepisodes

Wound oozing/bleeding 4

GI bleed 2

Haematuria in catheterised patient 1

Bleed from drain 2

Off-label use of rivaroxaban Number of

patients

Revision of TKR 3

Revision of THR 3

Patella resurfacing 2

Hip resurfacing 2

Uni-compartment knee replacement 2

Fractured neck of Femur leading to THR 1