E3 Rapid Fire: Stop the Clot! C. O'Quinn


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  • Due to the geographical span of VCH, we do a “sequential” style of accreditation, with each entity being surveyed in a different year of the 3-year cycle. Richmond, Vancouver, Coastal and the North Shore, Sea-to Sky, Sunshine Coast, and Powell River. Central Coast and Bella Bella and Bella Coola Communities. Our last visit at Richmond was in November 2006, when VCH’s last 3-year accreditation cycle started. During that visit, they also surveyed the corporate enabling systems: IMIS, Employee Engagement, the physical environment (Facilities and some of the contracted services like food and housekeeping), and Leadership & Partnership, which looks at the governance of VCH. This yea is the start of a new accreditation cycle, beginning again with Richmond HSDA. However, doe to the ongoing changes in how support services are delivered across BC and the Lower Mainlaind, the aspects of Effective Organization and Governance will be the subject of next year’s site visit rather than being included this year.
  • So why should we care? Well, we should care because VTE is a common problem. About 70% of ALL venous thromboembolism are related to hospitalization. So if we do a better job at preventing VTE in the hospital, there will be fewer VTE in the community. It is an expensive problem. There are no reliable Canadian costs, but estimates from the US and UK suggest that 1.5 billion dollars and 640 pounds are spent annually on thrombosis conditions. VTE is also burdensome. Not only does it take your breath away and it’s a pain in the leg, it interferes with other therapies and life styles, reduces work productivity, poses emotional and financial stress to patients, and reduces quality of life. VTE is also associated with chronic and costly complications. About 1/3 develop post thrombotic syndrome, 4% develop pulmonary hypertension, and up to 20% experience some bleeding while on anticoagulant therapy. VTE is also deadly. Up to 10% of deaths in hospital are directly or indirectly due to PE. And finally, VTE is preventable. In fact, it is the most common preventable cause of death in hospital.
  • So let’s do the right thing. After all, the weight of evidence, strongly supports that ….
  • E3 Rapid Fire: Stop the Clot! C. O'Quinn

    1. 1. Implementation of a VenousThromboembolism (VTE) Prevention Program Across VCH Vancouver Coastal Health Quality and Patient Safety Claire O’Quinn
    2. 2. Vancouver Coastal Health Authority• Serves 25% of BC population• Over 1 million people with primary and secondary care• 4 million people with tertiary and quaternary care• One of 6 Health Authorities in BC• 58,560 km2 in Richmond, Vancouver, North Shore, Sunshine Coast, Powell River and Sea to Sky communities• 2 Denominational Affiliates
    3. 3. Vancouver Coastal Health VCH AIM 2006 Squamish General Hospital Powell River General Hospital Lions Gate Hospital •Vancouver General Hospital •UBC Health Sciences Centre Hospital •St. Paul’s Hospital Richmond St. Mary’s Hospital •Mount Saint Joseph Hospital Hospital3
    4. 4. Why should we care?• Venous thromboembolism (VTE) is … – Common: ~70% of VTE are related to hospitalization – Deadly: ~10% of all deaths in hospital – Associated with chronic, costly complications – Burdensome BC HA VTE is estimated @3000 annually VCH = 770 a third of these patients will develop long term complication such as post-thrombic syndrome or chronic pulmonary hypertension – Expensive: 1.5 billion in US and £640 million in UK – Preventable: most common preventable cause of death in hospital 1. Spencer Arch Intern Med 2007 4. Sadler J Royal Soc Med 1989 2. Spyropoulos Chest 2002 5. AHRQ 2001 3. British House of Commons 2005
    5. 5. Why should we care?• Thromboprophylaxis is the #1-ranked patient safety strategy in hospitalized patients• Venous Thromboembolism (VTE) Risk Assessment & Thromboprophylaxis are now Accreditation Canada Required Organizational Practice (ROP)• Venous Thromboembolism (VTE) is also one of the BC MoH Key Results Area (KRP) Agency for Healthcare and Research and Quality, Shojania 2001
    6. 6. The weight of evidence …• Strongly supports that prophylaxis reduces VTE risk, including symptomatic VTE and deaths• Demonstrates that sensible prophylaxis rarely causes clinically important bleeding or other adverse effects• Shows that effective tools are available to implement local strategies to reduce VTE• Indicates that prophylaxis is underutilized
    7. 7. Estimated VTE Burden in BC• Annual incidence of hospital-related VTE: Population Total VTE Hosp VTE Vancouver Coastal 1,092,358 1100 770 Fraser 1,541,479 1500 1050 Island 741,299 740 518 Interior 722,556 720 504 Northern 283,911 280 196 Total 4,381,603 4400 3080
    8. 8. Milestones• Project Team - April 2010• VCH-PHC Regional Policy - July 2010• VTE Regional Prevention Guidelines - Sept. 2010• Regional PPO - Sept. 2010• Working Groups developed at each Community of Care (Coastal, Richmond, Vancouver) - Oct. 2011• Toolkit developed - Nov. 2011
    9. 9. Goals VTE Program• Overall goal to improve patient safety through compliance with evidence based guidelines on Thromboprophylaxis and to reduce the incidence of preventable hospital acquired VTE
    10. 10. Key Elements VTE Program• Have every patient evaluated for his/her risk assessment of VTE on admission and transfer of service or area of care• Prescribed thromboprophylaxis appropriate for his/her level of risk• Document the rationale for any deviation from the recommended practice• All patients will have Pre-printed orders (PPO)• Serves as a guideline for care providers to provide evidence based practice
    11. 11. VTEPrevention isembedded inall admissionpre-printedordersThrom boprop hylaxis
    12. 12. VTEPrevention isembedded inall admissionpre-printedordersThrom boprop hylaxis
    13. 13. VTE Implementation/Spread• Timely & Effective Engagement – Across the Organization – Across CoC and PHC – Across programs and services – Front line Staff, Physicians and Residents – Teamwork
    14. 14. Teamwork
    15. 15. Implementation Plan/Spread• Each CoC formed a VTE working group • Pharmacists • Nursing Educator/Clinician • Physicians • Quality & Patient Safety • Unit Coordinators • Other
    16. 16. VTE Working Group Roles & Responsibilities• Identify all inpatient units requiring VTE prophylaxis• Review existing PPO than have reference VTE prophylaxis• Decide to adopt the regional PPO or imbed the required elements• Devise an implementation plan with timelines• Define the approach of your implementation• Identify workflow or processes that require change• Communicate the changes and new workflow• Educate Nurses, Pharmacists, Physicians etc.• Report Progress monthly to Project Group
    17. 17. Implementation/Spread• RH and VGH started their implementation January 2011• VGH -Surgery chose a staggered implementation• RH and VGH –The Medicine Program implemented all medical units at the same time• LGH – chose a staggered approach• Coastal Rural is yet to be implemented
    18. 18. Implementation/Spread• Chart reviews were done post completion of implementation and every 2 months• The results were analyzed and discussed with the teams for process improvement• PDSA cycles were used to identify the required system changes to ensure success.• Educational Toolkit for staff & patients developed which could be customized for each site
    19. 19. VTE Audit Results -VGH VGH VTE Audits100%80%60% % of Charts with VTE PPO40% # with Risk Assessement Completed % of Patients on Anticoagulants20% 0% Jan 11 Mar 11 May 11 July 11 Mar 12
    20. 20. Sustainability• Regional Chart Audits per month• 100 chart audits per facility over 100 beds• Report Audits results monthly to SLT• Report Audits results to clinical teams monthly• Report Audits on Scoreboard• Ongoing education
    21. 21. Lessons Learned• Engagement is KEY – It is continuous – All levels of the organization – It must be timely – Looks different at each level – Looks differently at each facility – Use of PSDA cycles assist with engagement
    22. 22. Lessons Learned• Process requiring review to facilitate implementation – Streamline approval process for PPOs regionally & locally – Decrease turnaround time for revisions and updates to existing PPOs – Removal of outdated PPOs – Access to PPOs online – Determine who responsibility it is to manage on line PPOs
    23. 23. Claire O’Quinn Director, Vancouver AcuteClinical Quality and Patient Safety CP 381 – 855 West 12th Ave. Vancouver, BC V5Z 1M9 Tel: 604.875.4111 ext. 68450 claire.oquinn@vch.ca