National VTE Audit Day Results

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Purpose of the Call:

Review the results of the National VTE audit day

Discuss lessons learned from the audit day – strengths and areas for improvement

Suggest future value of audits and audit tools for your organization

Gather ideas for future steps for implementation of VTE prophylaxis

Click the link below for more information and to watch the recorded webinar.

http://bit.ly/12QiAf5

Published in: Health & Medicine, Business
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National VTE Audit Day Results

  1. 1. www.saferhealthcarenow.caNational VTE Audit DayRESULTSBill Geerts & Artemis DiamantourosVirginia Flintoft, Anne MacLaurin and Alex TiteuCPSI Central Measurement TeamMay 2013
  2. 2. www.saferhealthcarenow.caDid you Join the Call Correctly?You JoinedCorrectly!There IS aphone iconbeside yourname.You JoinedIncorrectly!There is NOphone iconbeside yourname.If you joined incorrectly and there is NO phone iconbeside your name, click the audio button on the right-hand side of the screen, below the participant listPlease join the audio conference using a phone for better audio quality.1. For direct lines, choose “Call me at a new number”2. For lines with extension , choose “I will call in” and dial theaudio conference toll-free number found on the SessionInfo tab, and when prompted, enter the access code andattendee ID
  3. 3. www.saferhealthcarenow.caWebExPlease use the chat to askquestions during the presentation,or raise hand when we pause forquestions.
  4. 4. www.saferhealthcarenow.caNational VTE Audit DayRESULTSBill Geerts & Artemis DiamantourosVirginia Flintoft, Anne MacLaurin and Alex TiteuCPSI Central Measurement TeamMay 2013
  5. 5. www.saferhealthcarenow.ca
  6. 6. www.saferhealthcarenow.ca1. Methodology2. Audit participation3. Appropriate thromboprophylaxis use4. Types of thromboprophylaxis used5. Reasons for not using appropriatethromboprophylaxis6. Use of Preprinted order sets7. Feedback and discussionVTE Audit Day Results - Outline6
  7. 7. www.saferhealthcarenow.ca• National VTE Audit Day: April 10, 2013• Audit Sample:– General Internal Medicine and General Surgery• National webinar (Mar 26) - Call to Action• Engagement of sites & registration• Each site contacted by CMT:– Identification of audit sample– Creation of data collection formsVTE Audit Day - Overview7
  8. 8. www.saferhealthcarenow.ca• Launch of National VTE Audit: April 10, 2013• Data Collection: April 10 to 18– Extension for data submission to April 30• Error reports corrected and resubmitted byCentral Measurement Team (CMT)• Analyses conducted by CMT with data fromPatient Safety Metrics (PS Metrics)VTE Audit Day - Methodology8
  9. 9. www.saferhealthcarenow.ca1. Methodology2. Audit participation3. Appropriate thromboprophylaxis use4. Types of thromboprophylaxis used5. Reasons for not using appropriatethromboprophylaxis6. Use of Preprinted order sets7. Feedback and discussionVTE Audit Day Results - Outline9
  10. 10. www.saferhealthcarenow.caOverall Response Rate10Sites 118Patients 4,667
  11. 11. www.saferhealthcarenow.caResponses by Province11Sites118 sites4,667 patients
  12. 12. www.saferhealthcarenow.caResponses by Major Patient Group1264% N=4,62831%2%Sites2%
  13. 13. www.saferhealthcarenow.ca1. Methodology2. Audit participation3. Appropriate thromboprophylaxis use4. Types of thromboprophylaxis used5. Reasons for not using appropriatethromboprophylaxis6. Use of Preprinted order sets7. Feedback and discussionVTE Audit Day Results - Outline13
  14. 14. www.saferhealthcarenow.caAppropriate Thromboprophylaxis -Overall Rates1481%N=4,667%ofpatients
  15. 15. www.saferhealthcarenow.caAppropriate Thromboprophylaxis -By Major Patient Group1579%84%%ofpatients
  16. 16. www.saferhealthcarenow.caAppropriate Thromboprophylaxis -by Province16100%%ofpatients65%
  17. 17. www.saferhealthcarenow.caAppropriate Thromboprophylaxis -by Province and Major Patient Group17%ofpatients
  18. 18. www.saferhealthcarenow.caAppropriate Thromboprophylaxis -by Province and Region18Regions ReportingNational Average = 81%
  19. 19. www.saferhealthcarenow.ca1. Methodology2. Audit participation3. Appropriate thromboprophylaxis use4. Types of thromboprophylaxis used5. Reasons for not using appropriatethromboprophylaxis6. Use of Preprinted order sets7. Feedback and discussionVTE Audit Day Results - Outline19
  20. 20. www.saferhealthcarenow.caType of Thromboprophylaxis - Overall20• LMWH = dalteparin, enoxaparin, fondaparinux, nadroparin, tinzaparin• Other = apixaban, dabigatran, rivaroxaban, warfarin (only 6%)N=4,581 (3,619 on TPX)LMWH + LDH = 90%LMWH = 61%(4%)
  21. 21. www.saferhealthcarenow.caType of Thromboprophylaxis –by Major Patient Group21PatientgroupPatientson TPXLMWH LDH MechOnlyGen Med 2225 69.5% 20.8% 4.6%Gen Surg 1211 45.3% 45.6% 3.3%
  22. 22. www.saferhealthcarenow.caType of Thromboprophylaxis -by Province22
  23. 23. www.saferhealthcarenow.caType of Thromboprophylaxis -by Province and Major Patient Group23
  24. 24. www.saferhealthcarenow.caType of Thromboprophylaxis -by Province and Region24
  25. 25. www.saferhealthcarenow.ca1. Methodology2. Audit participation3. Appropriate thromboprophylaxis use4. Types of thromboprophylaxis used5. Reasons for not using appropriatethromboprophylaxis6. Use of Preprinted order sets7. Feedback and discussionVTE Audit Day Results - Outline25
  26. 26. www.saferhealthcarenow.caReasons for not usingThromboprophylaxis - Overall26(72.2%)(8.7%)(8.1%)(6.3%)N=767
  27. 27. www.saferhealthcarenow.caReasons for not using Thromboprophylaxis- by Major Patient Group27
  28. 28. www.saferhealthcarenow.caReasons for not usingThromboprophylaxis - by Province28
  29. 29. www.saferhealthcarenow.caReasons for not using Thromboprophylaxis- by Province and Major Patient Group29
  30. 30. www.saferhealthcarenow.caReasons for not using Thromboprophylaxis- by Province and Region30
  31. 31. www.saferhealthcarenow.ca1. Methodology2. Audit participation3. Appropriate thromboprophylaxis use4. Types of thromboprophylaxis used5. Reasons for not using appropriatethromboprophylaxis6. Use of Preprinted order sets7. Feedback and discussionVTE Audit Day Results - Outline31
  32. 32. www.saferhealthcarenow.caPreprinted Order Use - Overall Rates32N=4,66755%%ofpatients
  33. 33. www.saferhealthcarenow.caPreprinted Order Use –by Major Patient Group33%ofpatients57%51%
  34. 34. www.saferhealthcarenow.caPreprinted Order Use – by Province34%ofpatients
  35. 35. www.saferhealthcarenow.caPreprinted Orders –by Province and Major Patient Group35%ofpatients
  36. 36. www.saferhealthcarenow.caPreprinted Orders –by Province and Region36%ofpatients100%3%
  37. 37. www.saferhealthcarenow.caReceiving Appropriate Thromboprophylaxisand Preprinted Order Sets37N=4,518OrdersetusedOrderset notused91%71%
  38. 38. www.saferhealthcarenow.ca• 1st Canadian national VTEthromboprophylaxis audit• 118 centres and 4,667 patients• Coast to coast representation• Medical and surgical patients wellrepresentedSummary - Participation38
  39. 39. www.saferhealthcarenow.ca• Overall, thromboprophylaxis use = 81%- Very good (but with room for improvement)• Variability in thromboprophylaxis use:- By patient group:– General surgery 84%– Medical 79%- By province: 65%  100%- By region within provincesSummary – Thromboprophylaxis Use39
  40. 40. www.saferhealthcarenow.caSummary – Types of Thromboprophylaxis40• Types of Thromboprophylaxis:• LMWH: 61%• LMWH + LDH: 90%• Mechanical only: 4%• Variability:• By Patient Group:• Medical: LMWH vs. LDH (70% vs 21%)• Surgical: LMWH and LDH similar (45% and 46%)• By province• By region within provinces
  41. 41. www.saferhealthcarenow.ca• Overall:– 19% did not receive appropriatethromboprophylaxis• Reasons:• No thromboprophylaxis 70%• Delay in start 9%• Wrong dose 8%• Modality varied from SHN recommendation 6%Summary – Reasons for not usingThromboprophylaxis41
  42. 42. www.saferhealthcarenow.ca• 55% of patients had admission / postop OS• Huge differences by province (13%  63%)and region• Appropriate thromboprophylaxis was morecommon if OS used (71% vs 90%)Summary – Order set use42
  43. 43. www.saferhealthcarenow.ca• Some provinces not represented:– Quebec, NMT, Yukon, Nunavut• Potential participation bias:– ?good centre bias– ?good nursing unit bias• Snap shot AuditSummary - Limitations43
  44. 44. www.saferhealthcarenow.ca1. Methodology2. Audit participation3. Appropriate thromboprophylaxis use4. Types of thromboprophylaxis used5. Reasons for not using appropriatethromboprophylaxis6. Use of Preprinted order sets7. Feedback and discussionVTE Audit Day Results - Outline44
  45. 45. www.saferhealthcarenow.ca• Less than 20% response rate• 2/3 rated the tool at very good –excellent• 2/3 indicated that they would continue touse the tool to collect VTE data• 100% indicated they would participate inanother audit day next year• We still want to hear from you!Feedback Survey link:http://survey.patientsafetyinstitute.ca/n/zzzfm.aspxVTE Audit Day Feedback Survey
  46. 46. www.saferhealthcarenow.caThank you!46• Questions• Comments/suggestions• How can SaferHealthcare Now! helpyou?
  47. 47. www.saferhealthcarenow.caThank you!Central Measurement Teammetrics@saferhealthcarenow.caVirginia Flintoft – 416-946-8350Alexandru Titeu – 416-946-310347

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