VTE Risk Assessment in Lower Limb Immobilisation

Quality Improvement Poster Download

Background & Problem

• Immobilised patients are at higher risk of venous thromboembolism (VTE) – deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Temporary limb immobilisation is implicated as a factor for VTE in 1.5-3% of all VTE events.
• Incidence of VTE in patients with lower limb immobilisation is estimated to be anywhere between 5 and 39%.
• DVT/PE are potentially life threatening complication
• Steps can be taken to prevent them if adequate risk assessment is undertaken
• Examples of VTE events in lower limb immobilisation have occurred in our trust.

Aim

Improve the assessment of VTE risk in ED patients (≥17 years) with lower limb immobilisation in plaster cast by 20-30% from baseline by 30th April 2016.

Method

Data for Jan – Nov 2015 was collected prior to implementation of change

Data for Jan – March 2016 was collected as changes were implemented

• Cycle 1 – Jan 2016 – Doctors handover and poster
• Cycle 2 – Feb 2016 – Risk assessment tray and prompts
• Cycle 3 – March 2016 – ENP meeting attended, communication with ENP as major stakeholder. Delayed due to difficulties attending meeting (strikes!)

Results

• None of the changes we implemented had any significant impact on our rate of assessment.
• Our rate of assessment is poor. Nationally, the target is complete compliance.
• Further steps need to be undertaken to improve this.
• High turnover of staff is a significant limiting factor to education.
• Difficult to find times to target all staff due to shift pattern – target induction?
• Lack of enthusiasm for VTE drawer – plaster packs?
• Much of the work conducted in ED stems from the IT system – could be a crucial target when Smartcare comes in.

Implications/Next Steps

• Changes to Patient First system would take significant time to achieve and would be phased out with Smartcare anyway
• Chose to avoid targeting reception staff; felt it was unfair to target non-clinical staff before clinical staff engaged
• National audit calls for use of a specific leaflet on VTE risk – does not exist in our trust. Considered to be outside of the scope of our QI project.
  

Next Steps

• Snail mail and email to ENPs
• Initiation of personalised feedback system
• Plaster packs
• Presentation in doctors induction
• Re audit Nov 2016