vte prevention - an electronic vte solution for nsw · revised policy directive tools . vte risk...
TRANSCRIPT
Venous Thromboembolism (VTE) Prevention
An Electronic Solution for NSW
Selvana Awad & Catriona Middleton-Rennie
• Provide an overview of the development process
• Demonstrate the Electronic VTE Risk Assessment Tool
• Share learnings from the pilot • Share learnings from WSLHD’s implementation
journey • Discuss and plan implementation requirements
2
Objectives
• Standardised, systems approaches to VTE Prevention
• Use of standardised tools are effective in: – improving the reliability and
consistency of VTE prevention processes
– ensuring that patient’s management is appropriate based on individual VTE risk factors and bleeding risks
– reducing the incidence of hospital-associated VTE
3
What does the literature say?
4
The VTE Prevention Program
Guidelines
VTE Prevention Framework
Revised Policy Directive
Tools
VTE Risk Assessment Tool
Electronic support through eMR
Audit / performance monitoring tool
Non-fatal VTE Incident Management Tool
Revised NIMC with dedicated VTE section
Education and Raising Awarenss
eLearning module for clinicians
Educational resources for clinician training
Patient education material
Posters focused on patients, and clinicians
• VTE Prevention Expert Advisory Group with state-wide representation established
• Multidisciplinary experts: surgeons, physicians, nurses, pharmacists, clinical governance
• Aim: develop a fit-for-purpose tool for NSW
5
Developing a tool for NSW
• No consensus regarding the preferred VTE risk assessment tool. – Quantitative vs Qualitative
models, pros and cons • Ideally, tools should have
these elements: – Identify patients at risk of VTE – Identification of bleeding risks – Prescribing
recommendations/guidance – Easy to use – Integrated within clinical
practice and workflows
6
Which tool? Chapter 4 of AHRQ Guide
• State-wide study conducted evaluating 5 risk assessment tools: 1. VTE Risk Assessment, Clinical Excellence Commission 2. ClotStop VTE Risk Assessment, Liverpool Hospital 3. Risk Assessment for VTE, King’s College Hospital, London 4. VTE Risk Assessment and Prophylaxis Orders, San Diego Medical
Center 5. Risk Assessment Checklist for VTE, PD2010_007
• 9 patient scenarios, 30 participants from across the state • Evaluated:
1. Reliability (outcomes correlated with gold standard) 2. User acceptability
7
The Process
• 300 assessments completed and 30 surveys returned
• Reliability (correlation with gold standard): – Risk assessment outcome:
VTE Risk Assessment and Prophylaxis Orders, San Diego Medical Center
– Treatment outcome: Risk Assessment for VTE, King’s College Hospital, London (however other tools were comparable)
8
Results
75.9 66.7
85.2 88.9
65
0
20
40
60
80
100
Original CECtool
ClotStop tool,LiverpoolHospital
King's Collegetool
San DiegoMedical
Center tool
Checklist inVTE
PD2010_007
Perc
enta
ge
Risk Assessment Correlation with Gold Standard
51.7 53.3 63.3
53.3 51.7
010203040506070
Original CECtool
ClotStoptool,
LiverpoolHospital
King'sCollege tool
San DiegoMedical
Center tool
Checklist inVTE
PD2010_007
Perc
enta
ge
Treatment Correlation with Gold Standard
Question Original CEC tool
ClotStop tool, Liverpool Hospital
King’s College tool
San Diego Medical Center tool
Checklist in VTE PD
1. Which tool was the easiest to complete? 16.7% (5) 16.7% (5) 26.7% (8)
33.3% (10)
6.7% (2)
2. Which tool was the best in regards to layout and flow?
16.7% (5) 13.3% (4) 30.0% (9)
30.0% (9)
10.0% (3)
3. Which tool provided the most helpful guidance to reach a VTE risk outcome?
13.3% (4) 6.7% (2)
36.7% (11)
36.7% (11)
6.7% (2)
4. Which tool best helped to identify a bleeding risk and/or contraindication to pharmacological and/or mechanical prophylaxis?
13.3% (4) 6.7% (2)
36.7% (11)
26.7% (8)
13.3% (4)
5. Which tool provided the best clinical decision support to guide prophylaxis?
13.3% (4) 6.7% (2)
40.0% (12)
26.7% (8)
13.3% (4)
6. Which tool would you most prefer to use overall?
16.7% (5) 10.0% (3)
33.3% (10)
33.3% (10)
6.7% (2)
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Results – User Acceptability
Decision made by VTE Expert Advisory Group to adapt San Diego Medical Center tool for use in NSW. Review and endorsement process undertaken (modifications made).
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The NSW VTE Paper Tool
11
About the San Diego Tool
Agency for Healthcare Research and Quality. 2016. Preventing Hospital-Associated Venous Thromboembolism. A Guide for Effective Quality Improvement: https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/vtguide/index.html
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“Compared to baseline, patients benefitting from [computerised] VTE CDS were 35% less likely to have a VTE” Amland et al. 2014 “The VTE rate declined from 0.954 per 1000 patient days to 0.434 comparing baseline to full [computerized] VTE CDS” Amland et al. 2014 “[Computerized] CDS systems with embedded algorithms, alerts, and notification capabilities enable physicians at the point of care to utilise guidelines and make impactful decisions to prevent VTE.” Amland et al. 2014 “Embedding VTE prevention practice into routine care, supported by electronic solutions and combined with dedicated VTE training led to continued improvement in overall risk assessment.” Roberts et al. 2013 “Without increasing the risk of bleeding, a CDS system requiring clinicians to document VTE risk assessment in the electronic medical record (EMR) promoted improved rates of pharmacological prophylaxis at any time during an admission and a decreased risk of VTE in general medical patients” Galanter et al. 2010
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The Evidence for Electronic Solutions
An Electronic VTE Solution for NSW
• Electronic VTE Risk Assessment tool in the eMR (based on the paper version) developed in collaboration with eHealth NSW and the VTE Expert Advisory Group
• It serves as a standardised documentation tool and provides clinical decision support: – Assigning VTE risk level (Higher, Moderate, Lower) – Guidance for prescribing prophylaxis
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Two-phased Evaluation Phase 1: Testing on nine patient scenarios in a controlled environment to evaluate user acceptance and assessment outcomes. • 80% of users found the e-RAT easy to use and
useful for assessing and managing VTE risk. • A number of usability issues such as the lack
of reference text recognition were identified.
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Correlation with Gold Standard • 26 out of 27 (96%) risk assessment outcomes
and 18 out of 27 (67%) treatment outcomes correlated with ‘Gold Standard’.
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Time Taken • Average time taken to complete an assessment using the e-
RAT decreased from 7.8min to 3.5min after the completion of four assessments (n=27; range, 2 min - 12 min)
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Time Taken Prior to testing, the JMOs involved in the study were asked how long they were willing to spend on conducting a VTE risk assessment using a tool. This is what they said….
18
‘5-10 minutes’ (x2 users) ‘Maximum 10 minutes’ ‘1-2 minutes per patient’ ‘1 minute’
JMO Comments Do you have any comments comparing the paper and electronic tools? Do you have a preference and if so, why? ‘I would prefer electronic as it is quicker to fill out and less likely to lose but I feel paper contained more information which was useful.’ ‘Electronic will be easier to navigate and will ensure that medical team fill it out if it comes up as an ‘Alert’ in the patient file. Paper forms are hardly used.’ ‘eMR version has built in fail safe/redundancies so that one cannot contradict oneself like in the paper version.’
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Phase 2 • When the e-RAT was used, 76% of prophylaxis prescribing was
appropriate.
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Phase 2 • There was limited use of the e-RAT during the
live pilot, possibly due to: – Initial implementation process (mass roll-out) – Limited understanding of workflow – Passive prompting mechanisms (reliance on the
Patient Summary Screen) – Culture and behaviour around conducting and
documenting a formal VTE risk assessment
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Release & Supporting Resources • Modifications made based on findings from the
evaluation • Released state-wide • PowerPoint available on CEC website:
http://www.cec.health.nsw.gov.au/patient-safety-programs/adult-patient-safety/vte-prevention/education
• eLearning module for clinicians under development • eMR supporting resources:
– Change Management Guide – Quick Reference Guide – Design Document
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23
Using the Electronic VTE Tool
Identify VTE Risk Factors
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Identify contraindications and Other conditions to consider with pharmacological prophylaxis
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• Consider tool’s recommendations. • Indicate prescribing decision.
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Prescribing VTE Prophylaxis
For suggestions on pharmacological and mechanical agents, right click inside the adjacent box and choose Reference Text.
Prescribing Options
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Important Elements for Implementation • Multi-faceted, systems approach • Relevant stakeholders are identified and engaged
• Oversight of senior clinical and managerial staff • Identification of champions • Education and training requirements • Link to the prescribing process • Consideration of workflows and electronic functionalities to
embed into practice • Use of data to drive change
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“Engaging clinical staff with the VTE prevention process required multiple tailored approaches, based around perceived drivers within different staff groups” Roberts et al. 2013
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WSLHD’s Implementation Journey and Learnings
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WSLHD timeline De
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VTE Prevention Program – project plan stage 1
To safely reduce preventable Hospital Associated (HA) VTE < 5% by November 2016
Outcome Measure: How much? By when? Data source: HIE coded data
Increase identification of patients potentially at risk for HA VTE
Process Measure: 50% increase in completed electronic VTE risk assessments in 6 months Data source: VTE electronic data extract
Process Measure: In 6 months 95% of identified at risk patients have appropriate prophylaxis prescribed Data source: VTE electronic data extract
Increase the number of patients that have appropriate administration of the prescription
Increase the number of patients prescribed appropriate prophylaxis
Increase the learning from hospital associated VTE
Increase Clinical Leadership
Increase use of Clinical Pathways
Increased use of Risk Assessment Tools
Increase medical Clinical Leadership
Increase Pharmacy input
Increase the accuracy and availability of data to enable learning
Education
Attitude / Leadership
Clinical
System
Data
Governance
Aim:
Outcome Measure: How much? By when?
Change concept categories
Process Measure: 30% increase in completed VTE RA within 24 hours of admission in 6 months Data source: VTE electronic data extract
The risk of VTE is increased 100 times when admitted to hospital. 7% of hospital deaths are as a result of hospital associated VTE.
The Problem:
Process Measure: within 6 months 95% of identified at risk patients have appropriate prophylaxis administered as prescribed Data source: Yearly point prevalence audit
Process Measure: 30% increase in completed electronic VTE RAT in 6 months Data source: VTE electronic data extract
Balancing Measure: The number of major bleeds that occur for patients who are prescribed and administered VTE prophylaxis
Team Members: • Team Leader – • Consumer • VTE EAG • Facility working parties • Project Sponsor – Clinical Governance
Increase identification of patients potentially at risk for HA VTE
Identifying patients at risk
In 8 months there will be a 40% increase in the number of admitted patients who have a documented VTE risk assessment completed
Outcome Measure: 50% of admitted patients will have a completed electronic VTE risk assessment in 6 months Data source: VTE electronic data extract
Increase Clinical Leadership
Process Measure: 30% increase in completed electronic VTE risk assessment tool in 6 months Data source: VTE electronic data extract
Increased use of Risk Assessment Tools
Increase use of Clinical Pathways
Increase and enable appropriate education
Improve leadership/ attitude
Improve system
Team Members: • Team Leader – • Consumer • VTE EAG • Facility working parties • Project Sponsor – Clinical Governance
The Problem:
Outcome Measure: 30% of admitted patients will have a completed electronic VTE risk assessment within 24 hours of admission in 6 months Data source: VTE electronic data extract
Inconsistent approach to the accurate and timely identification of patients potentially at risk for HA VTE
Enable appropriate education
Enable improved clinical practice
Improve leadership/ attitude
Enable appropriate education
Solution Impact Implementation
Present data and the RAT to senior medical staff High Easy
JMO teaching on VTE cases & contraindications Low Easy
Involve consultants in education of JMOs re VTE risk assessment & prophylaxis
High Hard
Communicate with HOD’s explaining
• RAT • Rationale for use • Role of VTE Prevention EAG
High Easy
Create IT system for XXXX of RAT High Hard
Interdepartmental RAT use send stats to HOD weekly High Easy
Dedicated VTE stewardship staff and referrals High Hard
Department signing on to a commitment with HOD accountable for KPI High Hard
Substantive position for VTE CNC High Hard
Patient safety handover checklists to include VTE management Low Easy
Intranet site for pathways
Empower Nurse/MW’s to prescribe mechanical prophylaxis Low Easy
Laminated checklist tool wear with badge Low Easy
Lunchtime presentations – include free lunch & door prizes Low Hard
HETI online for nursing and medical modules Low Easy
Access to electronic practice site at JMO orientation and PRN High Easy
Medical Leadership quiz all VMOs and CMOs Low Hard
Medical & nursing in-services Low Easy
Medication chart with VTE RAT on it High Hard
Monthly Red Clot Award/Trophy for ward with highest VTE RAT compliance at each hospital
High Easy
VTE RAT to be completed by admitting Dr High Hard
Use electronic VTE RAT – real time weekly reporting to wards with stats reported on Quality Leader board & a competition between wards
High Easy
Weekly JMO competition per rotation High Easy
Have inpatient Thrombosis Thursday promote VTE RAT completion High Easy
Use electronic VTE RAT High Easy
Streamline online VTE RAT with JMO input High Easy
Nursing leadership on every ward to assist JMOs High Easy
Ensure RAT done as part of ward admission High Easy
VTE data & presentations at Grand rounds Low Easy
Link VTE RAT with EMM when prescribing prophylaxis High Easy
Create dashboard for live compliance reporting High Hard
VTE RAT at ward White Board meeting time High Easy
VTE RAT completed in ED High Hard
Redesign RAT to be of more clinical benefit High Hard
If paper tool VTE RAT part of ward clerk pack Low Easy
For electronic VTE RAT – computer stops until RAT completed High Hard
Aim:
Process Measure: within 6 months 95% of identified at risk patients have appropriate prophylaxis prescribed Data source: VTE electronic data extract
Process Measure: 30% increase in completed electronic VTE risk assessment tool in 6 months Data source: VTE electronic data extract
Process Measure: within 6 months 95% of identified at risk patients have appropriate prophylaxis prescribed Data source: VTE electronic data extract
Outcome Measure: In 8 months 60% of admitted patients will have clear documentation of a completed VTE risk assessment Data source: Yearly point prevalence audit
Process Measure: 80% of JMO’s engaged in weekly competition to complete VTE risk assessment tool within 6 months Data source: VTE electronic data extract
Process Measure: 80% of wards district wide compete for monthly Red Clot Trophy within 8 months Data source: VTE electronic data extract & Leader Board results
Use electronic VTE RAT Use electronic VTE RAT High Easy
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KEY TAKE HOME MESSAGE
START SMALL
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Blacktown Project Diagnostic Process
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Improve VTE risk assessment process
Driver Diagram: Brainstorming of barriers (causes of the problem) and solutions
Process Mapping
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• Mapped out current process • Identified opportunities for
completing the electronic VTE tool within the current workflow
– First PDSA cycle: test the completion of the eVTE tool at particular time points in one team
KEY TAKE HOME MESSAGE
One place does not fit all
Results – General Surgery
0.0%
34.0%
27.6%
35.7%
21.4%
31.0%
25.6% 24.1%
11.9%
18.4%
14.9%
8.3%
21.7%
4.3%
0.0% 0.0% 0.0% 0.0% 0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
8th - 12thAugust
15th - 19thAugust
22nd - 26thAugust
5th - 9thSeptember
12th - 16thSeptember
19th - 23rdSeptember
26th - 30thSeptember
3rd - 7thOctober
10th - 14thOctober
17th - 21stOctober
24th - 28thOctober
31stOctober -
4thNovember
7th - 11thNovember
14th - 18thNovember
21st - 25thNovember
28thNovember -
2ndDecember
5th - 9thDecember
12th - 16thDecember
Electronic VTE Risk Assessment Rate: General Surgery
Shadowing: tool used by EST team (JMO and registrar)
New JMO rotation: tool used by EST team (same registrar, new JMO)
New JMO rotation
New Registrar rotation: tool used by EST team (new registrar, same JMO)
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015
Wor
ksho
p 1/
2
Dec.
201
5 / J
an 2
016
Audi
t
Jan
2016
VTE
eRA
T
April
201
6 CE
C EC
LP
June
201
6 Bl
ackt
own
Proj
ect
Sep.
201
6 W
estm
ead
Proj
ect
Sep.
201
6 CE
C EC
LP
April
201
7 Au
dit
Now
……
Mar
. 201
6 W
orks
hop
2/2
Jan.
201
7 O
rient
atio
n
47
WSLHD timeline De
c. 2
014
Base
line
Audi
t
Feb
2015
VTE
RAT
rolle
d ou
t acr
oss t
he d
istric
t
Aug.
201
5 Sn
apsh
ot A
udit
Oct
. 201
5 M
O su
rvey
N
ov. 2
015
Wor
ksho
p 1/
2
Dec.
201
5 / J
an 2
016
Audi
t
Jan
2016
VTE
eRA
T
April
201
6 CE
C EC
LP
June
201
6 Bl
ackt
own
Proj
ect
Sep.
201
6 CE
C EC
LP
April
201
7 Au
dit
Now
……
Mar
. 201
6 W
orks
hop
2/2
Jan.
201
7 O
rient
atio
n
Sep.
201
6 W
estm
ead
Proj
ect
48
Patient presents to ED
Admitted to ED Acute Area
Admit to ward
Patient is seen by nurse in ED and allocated triage category
Allocated to geriatric team 1,2 or 3 before morning round & reviewed by that team
OPERA
Which area of ED allocated to?
Business hours?
Seen in morning by Geriatric Consultant during consultant round
D4C
Admitting Geriatric Registrar charts medications
YES
NO
Admit as inpatient? NO
Discharge home
YES
Unwell requiring review ?
YES
Next day a week day? YES NO
NO
ED Acute Area Average stay of ≤ 8 hours
Patient not reviewed
Pt seen by ED MO (JMO, RMO, general med registrar, ED consultant) and discussed with the Geriatric Consultant on-call. The Geriatric consultant decides if the patient will be admitted.
Pt is seen by Geriatric Registrar. Maybe discussed with Geriatric Consultant depending level of complexity. The Geriatric
Registrar or Consultant will decide if the patient will be admitted
HOPE Average stay of ≤ 6 hours
Admit as inpatient? NO
Discharge home
YES
Admitting ED MO charts medications
Admit to ward
OPERA D4C
Next day a weekday?
YES
NO Next day a weekday?
NO Unwell
requiring review ?
Blue pathway is working hours – Monday to Friday 08:00-17:00. Excludes public holidays.
Red and grey pathway is out of hours – 17:00-08:00, weekends and public holidays.
Prepared by Geriatrics and Clinical Governance September 2016
VTE Risk assess all new
admissions from the last
24 hours
VTE Risk assess all new
admissions from the last
24 hours
Current process for geriatric patients presenting to Westmead Hospital Emergency Department
VTE Risk assess all new admissions from
the last 24 hours
VTE Risk assess all new admissions from
the last 24 hours
49
Patient presents to ED
Patient is seen by nurse in ED and allocated triage category
Business hours?
Patient presents to ED
Patient is seen by nurse in ED and allocated triage
category
Patient seen in clinic and requires hospital admittance.
Transfer from another hospital
Referring hospital discusses with on call Haematology Consultant . H/Consultant accepts patient for admittance and allocates to haematological team 1,2 or Bone Marrow team as appropriate.
Patient allocated to haematological team 1,2 or Bone Marrow team as appropriate.
Request to transfer from another hospital
Referring hospital discusses with on call Haematology Consultant . H/Consultant accepts patient for admittance and allocates to haematological team 1,2 or Bone Marrow team as appropriate.
Allocated to ED Acute Area or ESSU Average stay of ≤ 10 hours
Pt is seen by haematology Registrar and will be discussed with haematology Consultant. The H/Consultant will decide if the patient will be admitted.
Admit as inpatient? NO
Discharge home Admitting Haematology Registrar charts medications
YES
Admit to ward
Next day a weekday?
Blue pathway is working hours – Monday to Friday 08:00-17:00. Excludes public holidays.
Red and grey pathway is out of hours – 17:00-08:00, weekends and public holidays.
Prepared by Haematology and Clinical Governance September 2016
Patient allocated to haematological team 1,2 or Bone Marrow team as appropriate.
Bed available?
Admit to ward
C5A /Outlier
Patient came from
clinic?
Medications charted?
Haematology Registrar/Resident from allocated team charts medications
YES
YES
YES
YES
Reviewed by allocated team on morning round
Admit to ward
Pt seen by ED MO (JMO, RMO, general med registrar, ED consultant) and discussed with the Haematology Consultant or Haematology Advanced Trainee on-call. The Haematology consultant decides if the patient will be admitted.
Patient allocated to haematological team 1,2 or Bone Marrow team as appropriate.
Admitting ED MO charts medications
Seen in morning by Haematology Advanced Trainee
Patient reviewed by after hours resident (not from team). Haematology Consultant may be rung for advice.
After hours Resident charts medications
Medications charted in
clinic?
NO
NO
NO
NO
NO YES
Admit as inpatient?
NO Discharge home
YES
Next day a weekday?
Unwell requiring review ?
Unwell requiring review ?
Patient not reviewed
YES NO
NO
NO
Admit to ward
Next day a weekday?
YES
C5A /Outlier C5A /Outlier
C5A /Outlier
YES
Allocated to ED Acute Area or ESSU Average stay of ≤ 10 hours
NO
Booked admission
Bed available?
YES
NO
VTE Risk assess all new
admissions from the last
24 hours
VTE Risk assess all
new admissions
from the last 24 hours
Current process for Haematology patients presenting to Westmead Hospital
VTE Risk assess all new admissions from the last
24 hours
VTE Risk assess all new admissions from the last
24 hours
Data Oct. 2016 – Jan. 2017
50
0
2
4
6
8
10
12
Oct-16 Nov-16 Dec-16 Jan-17
Num
ber V
TE e
RAT
com
plet
ed
VTE eRAT
VTE eRAT
KEY TAKE HOME MESSAGE START SMALL
GET SMALLER
Oct. 2016 – Aug. 2017
51
0
5
10
15
20
25
30
Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17
Num
ber V
TE e
RAT
com
plet
ed
Haematology
Oct. 2016 – Aug. 2017 spread
52
0
5
10
15
20
25
30
Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17
Spread of VTE eRAT completion
Haematology Other
53
WSLHD timeline De
c. 2
014
Base
line
Audi
t
Feb
2015
VTE
RAT
rolle
d ou
t acr
oss t
he d
istric
t
Aug.
201
5 Sn
apsh
ot A
udit
Oct
. 201
5 M
O su
rvey
N
ov. 2
015
Wor
ksho
p 1/
2
Dec.
201
5 / J
an 2
016
Audi
t
Jan
2016
VTE
eRA
T
April
201
6 CE
C EC
LP
June
201
6 Bl
ackt
own
Proj
ect
Sep.
201
6 CE
C EC
LP
Sep.
201
6 W
estm
ead
Proj
ect
April
201
7 Au
dit
Now
……
Mar
. 201
6 W
orks
hop
2/2
Jan.
201
7 O
rient
atio
n
54
VTE Risk Assessment Tool
33
1
108
94
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
141
95
2017
2015
VTE RAT used VTE RAT not used
Use of VTE RAT
55
Back to our Project Plan Identifying patients at risk - results
Inconsistent approach to the accurate and timely identification of patients potentially at risk for HA VTE
In 8 months there will be a 40% increase in the number of admitted patients who have a documented VTE risk assessment completed
Outcome Measure: 50% of admitted patients will have a completed electronic VTE risk assessment in 6 months Data source: VTE electronic data extract - April 2017 - 0.62% Data source: 2015 Yearly point prevalence = 1.05% 2017 Yearly point prevalence audit = 23.4%
Outcome Measure: 30% of admitted patients will have a completed electronic VTE risk assessment within 24 hours of admission in 6 months Data source: VTE electronic data extract
Outcome Measure: In 8 months 60% of admitted audited patients will have clear documentation of a completed VTE risk assessment
Data source: 2015 Yearly point prevalence = 1.05% 2017 Yearly point prevalence audit = 30.7%
What we have learnt… • Think small – get smaller • Process map then PDSA - PDSA - PDSA • Pick one point in time • Data • Have prepared answers for the naysayers • Governance Structure • Use your workforce • Led by a Senior Consultant works the best • Spread will happen
56
57
WSLHD timeline De
c. 2
014
Base
line
Audi
t
Feb
2015
VTE
RAT
rolle
d ou
t acr
oss t
he d
istric
t
Aug.
201
5 Sn
apsh
ot A
udit
Oct
. 201
5 M
O su
rvey
N
ov. 2
015
Wor
ksho
p 1/
2
Dec.
201
5 / J
an 2
016
Audi
t
Jan
2016
VTE
eRA
T
April
201
6 CE
C EC
LP
June
201
6 Bl
ackt
own
Proj
ect
Sep.
201
6 CE
C EC
LP
Sep.
201
6 W
estm
ead
Proj
ect
April
201
7 Au
dit
Now
……
Mar
. 201
6 W
orks
hop
2/2
Jan.
201
7 O
rient
atio
n
58
Discussion Activity
Brainstorming & Discussion Activity 3 minutes – individual reflection 10 minutes – group discussion 1) What do you already have in place that will
assist with the implementation of the electronic VTE risk assessment tool?
2) Potential challenges you might face when implementing the tool.
3) Pick one challenge that you intend to target first and plan your next steps.
59
Wrap Up & Next Steps • We would like to work with you
to: – Support implementation
(resources to be emailed) – Improve the tool – Trial active prompting
mechanisms to improve the tool’s visibility and integration within the workflow (eMR functionalities)
– Link to electronic prescribing – Explore the use of clinical
informatics • The future: more automation
60
References
61
• Agency for Healthcare Research and Quality. 2016. Preventing Hospital-Associated Venous Thromboembolism. A Guide for Effective Quality Improvement. 2016: https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/vtguide/index.html
• Amland RC, Dean BB, Yu H-T, Ryan H, Orsund T, Hackman JL, et al. Computerised clinical decision support to prevent vernous thromboembolism among hospitalized patients: proximal outcomes from a multiyear quality improvement project. Journal of Healthcare Quality. 2014;37:221-331.
• Galanter, WL, Thambi, M, Rosencranz, H, Shah, B, Falck, S, Lin, F, Nutescu, Lambert, B. Effects of clinical decision support on venous thromboembolism risk assessment, prophylaxis, and prevention at a university teaching hospital. American Journal of Health System Pharmacy. 2010;67:1265-1273.
• Roberts, LN et al. Comprehensive VTE Prevention Program Incorporating Mandatory Risk
Assessment Reduces the Incidence of Hospital-Associated Thrombosis. CHEST. 2013;144(4):1276-1281.
