This is the final article in a four-part series focused on the prevention of venous thromboembolism and the Canadian VTE audit. For more VTE stories, visit www.patientsafetyinstitute.ca
Alberta Health Services (AHS) has adopted the Patient Safety Metrics tool to facilitate quarterly audits on use of prophylaxis to prevent venous thromboembolism (VTE) in hospitalized patients. In the past 24 months, AHS has completed more than 7,500 audits, reviewing about 10 to 20 charts at rural sites and 60 charts at urban sites each quarter. A goal was set to achieve a VTE prophylaxis compliance rate greater than 85 per cent by March 31, 2015. Currently, VTE prophylaxis rates are in the 80 per cent range at AHS sites recently audited.
“The Patient Safety Metrics tool is easy to use and provides the right reports that allows you to do the comparisons that you need to do,” says Dr. Elizabeth MacKay, Medical Leader, Provincial VTE Prophylaxis Accreditation Working Group. “The ability to compare your results to national groups provides information that is invaluable.”
AHS has developed a province-wide approach to preventing venous thromboembolism in hospitalized patients. In 2012, a multi-disciplinary group of healthcare practitioners, including representatives from accreditation, quality, risk management, physicians and pharmacists from zones across the province joined together to develop a VTE policy and guidelines. Leads from each area then identified an individual to audit charts on a quarterly basis. Educational sessions were held to touch all groups and tools were posted to the website to support the auditing process. Reports are developed in a quality and safety measurement format and distributed so that each area can see their progress.
Order sets and pocket tools have been developed and embedded into AHS systems. With auditing and feedback and the use of the order sets, the percentage of patients receiving appropriate prophylaxis increased from a baseline of less than 50 per cent at rural sites to over 80 per cent among 85 per cent of the sites that took part in audits during the last year. The VTE team is now looking at order set usage and content to help them focus on pockets that still need improvement.
Throughout the initiative, AHS has had the support of both accreditation and quality teams to help facilitate the audit. During the Canadian VTE audit in October 2014, a blast was made across urban centres to capture sites that were transitioning to a new accreditation cycle. Having access to electronic health records and electronic order sets in the Calgary zone was an enabler in doing a virtual audit to gather data, without having to delve into medical charts for supporting information. The teams are able to look at variation in the use of prophylaxis in all populations and identify areas of specific need.
“To get change to occur it has to be focused,” says Dr. MacKay. “VTE does not belong to one group and one individual cannot do this work on their own. The multi-disciplinary approach helps to align your work and remove silos. Having VTE as a provincial mandate and aligning it with accreditation has allowed us to take this to a level we would not have achieved otherwise.”
AHS is now looking beyond the general medicine and general surgery focus to include critical care, cancer care, arthroplasty and transplant to leverage all areas that have the most to gain by examining the variation in use of VTE prophylaxis in these higher risk groups who are to be included in the next AHS accreditation cycle.
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 Capital Health is engaging frontline staff in auditing.
