This is the third article in a four-part series on the prevention of venous thromboembolism (VTE) and the 2014 Canadian VTE Audit. For more VTE stories, visit www.patientsafetyinstitute.ca
The National Venous Thromboembolism (VTE) audit came about at the right time for the Capital Health region in Nova Scotia. It had been about a year since new processes and policies on prophylaxis had been rolled out, along with staff education on VTE.
“The VTE audit provided some concrete data on how well we were doing and served as a barometer to look at how we had progressed over the year and how we compared with the rest of the country,” says Jane Palmer, Quality Leader, Capital Health.
Jane Palmer took ownership to ensure that everything was in place to participate in the Canadian VTE Audit at Capital Health. She first provided an educational session for team clinical leaders during their monthly quality and patient safety forum. She introduced the topic, explained why it was important to participate, outlined some of the things that had been done over the year and emphasized the opportunity to measure progress.
The approach to auditing at Capital Health typically involves and gives ownership of doing the audit to the frontline staff, or frontline team. “Auditing raises awareness and learning and we feel that frontline staff should decide on who is best on their unit to do the audit,” says Jane Palmer.
For the VTE audit, 30 inpatient units were invited to participate with a commitment to share results of the audit back to them. Jane reinforced that VTE prophylaxis should be a standard of care on their unit and asked them to select between five to 10 charts to audit. About 60 per cent of the inpatient units submitted data; auditing of charts was most often done by the charge or staff nurse on the unit.
With improvement in the use of appropriate prophylaxis over last year from 65 per cent to 80 per cent, the results have been shared with the clinical teams and a core group will continue to analyze the data to look for opportunities for improvement.
“Our results show where we need to do some work in our organization,” says Jane Palmer. “Educating the patient about VTE prophylaxis and pre-printed order sets (PPOs) are two areas that we need to lend some focus. We had done some work on PPOs to prepare for accreditation, however, additional VTE PPOs were subsequently developed and we are now in the process of supporting teams for full implementation. A physician champion on the team helped to support the outcome actions around physician behaviour change in utilizing PPOs. We will now step back and refocus on where we need to do some follow-up with front- line teams to ensure any current gaps in VTE prophylaxis-related processes are addressed.
Capital Health has found that PPOs do increase the appropriate prophylaxis being used. They have developed a standard PPO for VTE that any service can use and try to embed VTE into current order sets wherever possible, recognizing that some areas do not use PPOs on a regular basis. They have also found that old PPOs are being circulated, and lack of uptake by physicians in indicating VTE prophylaxis on the standard physician order sheet.
“We participate in national audits such as this, to evaluate how we provide care,” says Jane Palmer. “We have seen a change in our culture around performance measurement in terms of auditing. It is often a manual process that takes a fair amount of energy and it has been a culture shift for staff to understand why auditing is important. Staff have an interest in how we measure compared to other organizations as we encourage use of benchmarking to guide improvement plans and strategies. Audits prove to be a good opportunity to get staff engaged.”
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; Southlake Regional Health Centre and Queen Elizabeth Hospital outline how pharmacists led their organization’s participation in the Canadian VTE Audit; and how the Patient Safety Metrics tool is helping to facilitate quarterly VTE audits in Alberta.