Orthopaedic Department takes the lead on reducing Venous Thromboembolism (VTE)

Latest news 4 July 2016 |  Every year over 100 patients at Counties Manukau Health (CM Health) develop a significant hospital-associated VTE in the form of deep vein thrombosis (DVT) or pulmonary embolism (PE). 

Orthopaedic patients having hip and knee surgery fall into a high risk group for hospital-associated blood clots. Our Orthopaedic Department has taken the lead in this area and is currently working on ways to better assess high risk patients and ensure that they have appropriate risk assessment pre-surgery, and interventions to reduce their likelihood of getting a blood clot post surgery.  A key component of this work is reducing variation with managing these patients’ VTE and bleeding risks. Monthly data of hospital-associated VTE are routinely evaluated to identify opportunities for improvement.

A key aim is to increase the percentage of elective knee and hip joint surgery patients being VTE risk-assessed in preadmission clinic or within 24 hours of admission (from 0%) to 90% by the end of December 2016.

To achieve this, an interdisciplinary group is implementing a structured VTE prevention pathway for Orthopaedics to embed the key processes into routine practice, including:

  • VTE risk assessment of all patients at Orthopaedic preadmission clinics
  • VTE risk assessment of all patients as part of 'Time Out' in operating theatres
  • Decision making at the end of each surgical procedure regarding the appropriate thromboprophylaxis and charting thereof, prior to 'Check Out / Sign Out'
  • Close monitoring of potential complications associated with VTE prophylaxis

Use of the pathway is expected to result in each patient having a specific VTE prevention plan based on their individual VTE and bleeding risk.

The associated bundle of care includes:

  • Orthopaedic VTE risk assessment tool
  • VTE alert sticker for highlighting of VTE risk in the clinical notes
  • Template for dictation of VTE prevention plan in Orthopaedic preadmission clinic
  • Patient information pamphlet
  • Staff information pamphlet
  • Guideline and poster on how to use anti-embolic stockings
  • Outcome sheet that is used to monitor wound ooze, range of motion, wound swelling and anticoagulant used - electronic format in development
  • Electronic VTE prevention pathway in the electronic discharge summary (EDS) - in development

Other work associated with the Orthopaedic bundle of care involves:

  • Review of the VTE guideline
  • Ongoing auditing of the VTE risk assessment
  • Extending the bundle of care to private contract patients
  • Development of a nurse-led clinic for patient follow-up

Watch this space - roll-out of the Orthopaedic bundle of care will take place during the week starting 11 July 2016!