This is the second article in a four-part series on the prevention of venous thromboembolism (VTE). For more stories on VTE, visit www.patientsafetyinstitute.ca
In their day-to-day work, hospital pharmacists assess the use of prophylaxis to prevent venous thromboembolism (VTE) as part of the basic pharmaceutical care for patients. With this approach, it was the pharmacists at Southlake Regional Health Centre in Newmarket, Ontario and six hospitals in Prince Edward Island who would take the lead in participating in the Canadian VTE audit held in October 2014.
Southlake Regional Health Centre was looking for a standard way to measure and a formalized approach to evaluating their use of prophylaxis. Southlake has had a long journey to improve the use of prophylaxis to prevent VTE. They have put together a standard of care and focused on VTE as an ongoing quality improvement project. The biggest leap in improvement was noted when prophylaxis was incorporated into admission order sets.
“The national VTE audit is a fairly quick and relatively easy way to get a handle on how well you are doing,” says Patti Ferguson, Pharmacy Manager. “With VTE as one of the accreditation standards, everyone has a vested interest in knowing where they’re at. This is a great way to jump on board and ensure that you have the information that you need, while participating in a national audit.”
Ferguson says that filling out the audit forms took a little longer than expected, but it was a reasonable way to collect information. A brief meeting was held to ensure that everyone involved would be taking the same approach and the chart audits were conducted over one day, rather than several days.
“Depending on your systems, measuring success in VTE prophylaxis, or any other quality improvement project, is not that easy to do,” says Patti Ferguson. “The national VTE audit made it easy to evaluate your use of prophylaxis. We generated the paper, the assessment is done for you and the results are immediate.”
Southlake’s use of prophylaxis was in the 70 per cent range in the 2013 audit, increasing to 93 per cent for the 2014 audit. They are looking closely at their results, targeting areas where they need to improve and celebrating successes in areas that have excelled. A corporate overview of results has also been provided to the health centre’s Quality and Utilization Committee.
Queen Elizabeth Hospital in Charlottetown, Prince Edward Island was one of six hospitals across the province participating in the national VTE audit. This was the first time the audit was done provincially. Four pharmacists were involved in conducting the audit over a two week period. Initially, the team met by teleconference and then participated in the National VTE Audit webinar to get more information on data collection and have their questions answered about the audit.
“Taking part in the VTE webinar in advance helps to get information on collecting data and setting up forms,” says Beth Bradley, Pharmacist Clinical Coordinator. “It was great taking a team approach for the audit because we could fire questions back and forth amongst each other and bounce ideas off one another.”
Bradley says that the Patient Safety Metrics system used for the audit was very straightforward and easy to use. While information on how to conduct the audit was clear and easy to understand, there were many offers of assistance when she needed to help. She particularly liked the quick turnaround of results. Once submitted, results were available online within an hour.
Computerized physicians order entry has been instituted across Prince Edward Island and power plans (electronic order sets) are a part of the system. Having VTE as an option on the power plans has gone a long way in encouraging physicians to consider VTE prophylaxis. The data is being disseminated to the various medical and surgical quality teams and shared with each of the institutions.
“The VTE audit was more work than I thought it would be, but the information is helpful and a reminder of the importance of VTE prophylaxis,” says Beth Bradley.
Click on the links below to view more articles in the series: the Jewish General Hospital explains their VTE prevention strategies, including implementing a standardized time for the administration of prophylaxis; Capital Health is engaging frontline staff in auditing; and how thePatient Safety Metrics tool is helping to facilitate quarterly VTE audits in Alberta.