National VTE Audit Day: Results and Feedback

www.saferhealthcarenow.ca
National VTE Audit – October 2014
RESULTS
Bill Geerts & Artemis Diamantouros
Virginia Flintoft, Anne MacLaurin and Alex Titeu
CPSI Central Measurement Team
Nov. 2014

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1. Methodology
2. Audit participation
3. Appropriate thromboprophylaxis use
4. Types of thromboprophylaxis used
5. Reasons for not using appropriate
thromboprophylaxis
6. Use of Preprinted order sets
7. Feedback and discussion
VTE Audit Results - Outline
5

• National VTE Audit: October 1-15, 2014
• Audit Sample:
– General Internal Medicine and General Surgery
• National webinar (Sept. 8) - Call to Action
• Engagement of sites & registration
• Sites contacted by CMT:
– Identification of audit sample
– Creation of data collection forms
VTE Audit - Overview
6

• Launch of National VTE Audit:
• Data Collection: October 1 to 15
– Extension for data collection to October 31
– Data submission accepted up to November 7
• Error reports corrected and resubmitted by
Central Measurement Team (CMT)
• Data cleaning and Analyses conducted by CMT
with data from Patient Safety Metrics
(PS Metrics)
VTE Audit - Methodology
7

1. Methodology
thromboprophylaxis
8

Response Rate 2014 –
Original and Cleaned
10
Originally
Submitted
Oct. 2014
Cleaned
Oct.2014
Sites 112 110
Patients 3,937 3,809

Overall Response Rate –
2013 v 2014
11
Apr.
2013
Oct.
2014
Sites 118 110
Patients 4,667 3,809

Responses by Province – 2013 v 2014
13

Responses by Major Patient Group –
2013 v 2014
16
2014 (n)=3,809
2013 (n)=4,667

1. Methodology
thromboprophylaxis
17

Receiving Appropriate TPX -
Overall Rates
18
86%
N=3,809
% of patients

Appropriate TPX -
By Major Patient Group
19
84%
92%
% of patients
78% 86%

by Province
20
% of patients
Total (n)
National Average =86%

by Province and Major Patient Group
21
% of patients
Total (n)

Receiving Appropriate TPX
- by Province and Region
22
Regions Reporting
National Average = 86%
% of patients
Total (n)

1. Methodology
thromboprophylaxis
VTE Audit Day Results - Outline
23

Type of Thromboprophylaxis - Overall
25
• LMWH = dalteparin; enoxaparin; fondaparinux; nadroparin; tinzaparin
• Other = apixaban; dabigatran; rivaroxaban; warfarin (2013=6%; 2014=7%)
Year
Patients
on TPX
LMWH LDH Mech
Only
2013 3,619 61% 29% 4%
2014 2,601 60% 27% 6%

Type of Thromboprophylaxis
- by Major Patient Group
26
Patient
group
Patients on
TPX
LMWH LDH Mech
Only
Gen Med 1165 64% 24% 4%
Gen Surg 758 55% 33% 8%

Type of Thromboprophylaxis
- by Province
27
Total (n)

Type of Thromboprophylaxis -
28
Total (n)

1. Methodology
thromboprophylaxis
29

Reasons for not using TPX - Overall
30
(73%)
(6%)
(4%)
(8%)
N=434
(7%)

Reasons for not using TPX -
by Major Patient Group
31

1. Methodology
thromboprophylaxis
32

Preprinted Order Use –
Overall Rates – 2013 v 2014
34
N=3,809
49%
% of patients
55%

Preprinted Order Use –
By Major Patient Group
35
% of patients
51%
46%

Preprinted Order Use – by Province
36
% of patients
Total (n)
National Average =49%

Preprinted Orders –
37
% of patients
Total (n)

Appropriate Thromboprophylaxis and
Preprinted Order Set Use
38
94% N=3,771
78%

Receiving Appropriate Thromboprophylaxis
and Preprinted Order Sets – 2013 & 2014
39
94%
78%
91%
71%

Receiving Appropriate Thromboprophylaxis
and Preprinted Order Sets by Service
40
N=3,202
94%
96%
88%
75%

• 2nd Canadian national VTE
thromboprophylaxis audit
• 110 centres and 3,809 patients
• Coast to coast representation (almost)
• Medical and surgical patients well
represented
Summary - Participation
41

• After data cleaning 8 fewer sites participated
this year representing 858 fewer patients
• Half as many patients from Ontario and 3
times as many from AB; no data from NL but 5
sites from QC vs 0 in 2013
• 25% - 35% fewer cases reported for Gen. Med
and Gen. Surg; 50% - 68% more cases in Med-
Surg and Other Surg in 2014
Summary – 2013 vs 2014 Audits
42

• No difference in proportional use of
Thrombolytics by type
• Slightly less use of Pre-printed Order Sets in
2014 (49% v 55%)
• Appropriateness of Thrombolytics was slightly
better in 2014
• Using Order Sets - 94% v 91%
• Not using Order Sets – 78% v 71%
Summary – 2013 vs 2014 Audits
43

Summary of 2014 Data
44

• Overall, thromboprophylaxis use = 86%
- Excellent response but still room for improvement
- 14% of patients at risk for VTE did not receive
appropriate thromboprophylaxis
• Variability in thromboprophylaxis use:
- By patient group:
– General Surgery 92%
– General Medicine 84%
- By province: 70%  96%
- By region across provinces: 55%  100%
Summary – Thromboprophylaxis Use
45

Summary – Types of Thromboprophylaxis
46
• Types of Thromboprophylaxis:
• LMWH: 60%
• LDH: 26%
• LMWH + LDH: 87%
• Mechanical only: 5%
• Variability:
• By Patient Group:
• Medical: LMWH vs LDH (64% vs 24%)
• Surgical: LMWH vs LDH (56% and 33%)
• By province
• By region

• Overall:
– 14% did not receive appropriate thromboprophylaxis
• Reasons:
• No thromboprophylaxis 73%
• Delay in start 8%
• Wrong dose 5%
• Modality varied from SHN recommendation 7%
Summary – Reasons for not using
Recommended Thromboprophylaxis
47

• 49% of patients had admission / postop OS
• Huge differences by province (16%  69%) and
region
• Appropriate thromboprophylaxis more common
if OS used (94% vs 78%) – also in 2013
Summary – Order set use
48

• Territories not represented:
– NL, NWT, Yukon, Nunavut
• Some incomplete data submitted
• Potential participation bias:
– ?good centre bias
– ?good nursing unit bias
• Snap shot Audit
Summary - Limitations
49

1. Methodology
thromboprophylaxis
50

Thank you!
51
1. Questions
2. Comments/suggestions
and Learning
3. How can Safer
Healthcare Now! help
you?

Thank You / Merci
Evaluation Poll
Sondage d’évaluation

Thank you / Merci
Central Measurement Team
metrics@saferhealthcarenow.ca
Virginia Flintoft – 416-946-8350
Alexandru Titeu – 416-946-3103
53

National VTE Audit Day: Results and Feedback

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