NATIONAL VTE AUDIT CALL TO ACTION SEPTEMBER 10, 2014
Artemis Diamantouros, Bill Geerts & Virginia Flintoft
Gina Peck, An...
Please note your phone will be muted when you join the call
•
Thank you for joining us.
Nous vous remercions de votre p...
If there is NO audio:
S’il n’y a pas d’ audio de WebEx
1. Click the audio Icon. /
Cliquer sur l’icône audio.
2. A popu...
Interacting in WebEx: Today’s Tools Interagir dans WebEx: les outils d'aujourd'hui
Please use the chat to ask questions d...
•
Why participate in the VTE audit?
•
What did we learn last year?
•
How to complete the audit
•
Instructions for g...

Why participate in the VTE audit?

What did we learn last year?

How to complete the audit

Instructions for g...
Bill Geerts, MD, FRCPC
Thromboembolism Specialist, Sunnybrook Health Sciences Centre
Professor of Medicine, University o...
Why participate in the VTE audit?
1. Because 60% of all venous thromboembolism (VTE) in the population is hospital-acquir...
Burden of Hospital-Acquired VTE
Population of Canada, 2014
35,428,000
Annual VTE rate
35,428
1/1,000/yr
60%
Hospita...
Why participate in the VTE audit?
1.
Because 60% of all VTE in the population is hospital-acquired
2.
Because HA-VTE p...
Harms of Hospital-Acquired VTE
•Symptomatic DVT, PE
•Fatal PE
•Prolonged hospital stay (or readmission)
•Harm of thera...
Why participate in the VTE audit?
1.
Because 60% of all VTE in the population are hospital-acquired
2.
Because HA-VTE ...
Why participate in the VTE audit?
4. Because comprehensive thromboprophylaxis programs are expected by Accreditation Cana...
Why participate in the VTE audit?
4. Because comprehensive thromboprophylaxis programs are expected by Accreditation Cana...
Thromboprophylaxis improves clinically-important outcomes:
4 examples
Why participate in the VTE audit?
QI improves Thromboprophylaxis
1
Maynard – J Hosp Med 2010;5:10
54% 67% 80% 90% 98%
QI efforts also reduce VTE
Maynard – J Hosp Med 2010;5:10
2005
P
Patients at risk
9,720
11,207
Appropriate prophyla...
Thromboprophylaxis leads to Fewer Adverse Outcomes
Zeidan – Am J Hematol 2013;88:545
2.5%
1.1%
0%
0.5%
1.0%
1.5%
2...
•
QI project at King’s College Hospital launched in 2010 (aligned with national VTE program)
•
Development of a local V...
Patients with a VTE Risk Assessment
Roberts – Chest 2013;144:1276
% of patients
•
QI project at King’s College Hospital, London, 2010-12
VTE Prevention Program Reduces Hospital-Associated VTE
2010-11...
•
All patients admitted to all 163 NHS trusts, 2010-12
•
Mandatory reporting of use of the VTE risk tool
Use of the UK...
•
All 4 million patients admitted to all 163 NHS hospital trusts >3 days, 2010-12
Hospital-Acquired Fatal VTE is Reduced...
National VTE Mortality Data England
Year
VTE listed as
cause of death
2007
6,121
2008
6,170
2009
6,218
2010
6,2...
•
Why participate in the VTE audit?
•
What did we learn last year?
•
How to complete the audit
•
Instructions for g...
2013 National VTE Audit RESULTS
•
Audit April, 2013
•
118 centers, 4,667 patients, 9 provinces coast to coast
•
General medical and general surgical ...
•
Overall, thromboprophylaxis use = 81%
- Very good (but with room for improvement)
Thromboprophylaxis Use
Appropriate Thromboprophylaxis - by Province (2013)
% of patients
100%
65%
Types of Thromboprophylaxis
•
Thromboprophylaxis:
•
LMWH 61%
•
LMWH or LDH 90%
•
Mechanical only 4%
•
Variabilit...
•
Overall, 19% did not receive appropriate thromboprophylaxis
•
Reasons:
•
No thromboprophylaxis 70%
•
Delay in sta...
Reasons for not using Thromboprophylaxis
•
Overall, 55% of patients had preprinted order sets
•
Huge differences by province (13%  63%) and region
Order set u...
Impact of Preprinted Order Sets
N=4,518
Order set used
Order set not used
91%
71%
2014 National VTE Audit
•
Why participate in the VTE audit?
•
What did we learn last year?
•
How to complete the audit
•
Instructions for g...
•
When?
–
October 1 to 15, 2014*
•
Purpose:
–
Obtain a current estimate of national VTE prophylaxis rates
–
Incre...
•
Your commitment:
–
Approximately 60 minutes
•
Your essential contribution:
–
Helping to improve the delivery of s...
•
The VTE audit will again focus on:
–
Internal Medicine
–
General Surgery
•
Audit sample can be:
–
Both Medical ...
•
At least 20 patients from each group (medical, surgical)
•
4 options for determining audit sample:
1.
All eligible ...
•
Inclusion:
–
Patients in hospital on Oct. 1 AND with an actual or expected LOS of more than 2 calendar days
–
Patie...
•
Internal Medicine:
–
For example, patients admitted with:
•
CHF, severe respiratory disease, or confined to bed wit...
•
Collect data related to 4 questions:
1.
Were preprinted orders used on admission or after surgery?
2.
What type of ...
•
Direct Chart Audit!!
–
Go to the patient care unit
–
Determine patient eligibility
•
Chart Review/MAR
•
Report ...

Case 1: No VTE Prophylaxis was ordered
–
Column 1: answer NO
–
Column 2: select #12 “No Order”
–
Column 3: select...

Case 2: VTE Prophylaxis has been ordered for the patient
–
Column 1: look at whether an order set was used to order t...

Case 2: VTE Prophylaxis has been ordered for the patient
–
Column 3: decide whether the VTE prophylaxis was appropria...
NB: All patients included in the audit sample are eligible for thromboprophylaxis
•
Prophylaxis is considered appropriat...

Case 2: VTE Prophylaxis has been ordered for the patient
–
Column 4: if you answered NO to column 3, choose the reaso...
How to participate in the VTE Audit
1.
Use your VTE form from last years VTE Audit www.patientsafetymetrics.ca
2.
Register for VTE audit day and we will cr...
52
How to Request a Data Collection (Audit) Form
Completing Audit Form Request
Patient Safety Metrics An Overview
Features:
•
Cloud-based data collection and reporting tool
•
User friendly and simple to navigate
•
Accessible from ...
•
Data Collection Forms
–
Patient-level data (de-identified) - daily
–
Multiple data elements
–
Print form  Collec...
PS Metrics can be used to support:
•
Small and Large Scale Improvement Initiatives
•
Roll Up or Drill Down Reports [e....
Completing Audit Form - #1
Completing Audit Form - #1
Virginia Flintoft 416-946-8350, virginia.flintoft@utoronto.ca
Access to PS Metrics
60
https://psmetrics.utoronto.ca/metrics/login.aspx https://psmetrics.utoronto.ca/metrics/Login.asp...
•
Fax form in FINE RESOLUTION (setting on fax machine)
•
Use Flat-bed Fax Machines – feeder faxes produce lines
•
Do ...
Thank you … Questions?
62
Poll
Sondage
Thank you!
For any questions, contact: Virginia Flintoft – 416-946-8350 Artemis Diamantouros– 416-480-6100 x3654 Email: a...
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Canadian VTE Audit - Information Call

Objective ​Safer Healthcare Now!, a program of the Canadian Patient Safety Institute, invites you to participate in the Canadian VTE Audit, designed to establish a national perspective of VTE thromboprophylaxis rates and raise awareness of appropriate VTE prophylaxis. VTE is one of the most common and preventable complications of hospitalization and is a Required Organizational Practice (ROP) of Accreditation Canada. By participating in the national audit day you will be a part of a movement aimed at preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospital patients. Watch the recording: http://bit.ly/1wfinCE
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Canadian VTE Audit - Information Call

  • 1. NATIONAL VTE AUDIT CALL TO ACTION SEPTEMBER 10, 2014 Artemis Diamantouros, Bill Geerts & Virginia Flintoft Gina Peck, Anne MacLaurin and Alex Titeu
  • 2. Please note your phone will be muted when you join the call • Thank you for joining us. Nous vous remercions de votre participation. • Your line will be muted until the call begins. Les lignes seront sous- silence au début de cet appel.
  • 3. If there is NO audio: S’il n’y a pas d’ audio de WebEx 1. Click the audio Icon. / Cliquer sur l’icône audio. 2. A popup will display the phone information./ Une boîte de dialogue offre l’information téléphonique Direct Line Enter number Ligne directe, entrer votre numéro Line with Extension “ I will call in” Ligne avec poste Or/ou 964 667 095# # 3.
  • 4. Interacting in WebEx: Today’s Tools Interagir dans WebEx: les outils d'aujourd'hui Please use the chat to ask questions during the presentation, or raise hand when we pause for questions.
  • 5. • Why participate in the VTE audit? • What did we learn last year? • How to complete the audit • Instructions for getting and using your Data Collection Form Agenda
  • 6.  Why participate in the VTE audit?  What did we learn last year?  How to complete the audit  Instructions for getting your Data Collection Form Agenda
  • 7. Bill Geerts, MD, FRCPC Thromboembolism Specialist, Sunnybrook Health Sciences Centre Professor of Medicine, University of Toronto National lead, VTE Prevention, Safer Healthcare Now! Why participate in the VTE audit?
  • 8. Why participate in the VTE audit? 1. Because 60% of all venous thromboembolism (VTE) in the population is hospital-acquired
  • 9. Burden of Hospital-Acquired VTE Population of Canada, 2014 35,428,000 Annual VTE rate 35,428 1/1,000/yr 60% Hospital-acquired VTE rate 21,300/year
  • 10. Why participate in the VTE audit? 1. Because 60% of all VTE in the population is hospital-acquired 2. Because HA-VTE produces substantial patient harm
  • 11. Harms of Hospital-Acquired VTE •Symptomatic DVT, PE •Fatal PE •Prolonged hospital stay (or readmission) •Harm of therapeutic anticoagulation •Patient anxiety •Costs of diagnosis and treatment •Future consequences
  • 12. Why participate in the VTE audit? 1. Because 60% of all VTE in the population are hospital-acquired 2. Because HA-VTE produces patient harm 3. Because HA-VTE can be prevented (effectively, safely, inexpensively)
  • 13. Why participate in the VTE audit? 4. Because comprehensive thromboprophylaxis programs are expected by Accreditation Canada and are expected by our PATIENTS
  • 14. Why participate in the VTE audit? 4. Because comprehensive thromboprophylaxis programs are expected by Accreditation Canada and are expected by our PATIENTS 5. Because it is essential to measure our compliance with this safety standard of care
  • 15. Thromboprophylaxis improves clinically-important outcomes: 4 examples Why participate in the VTE audit?
  • 16. QI improves Thromboprophylaxis 1 Maynard – J Hosp Med 2010;5:10 54% 67% 80% 90% 98%
  • 17. QI efforts also reduce VTE Maynard – J Hosp Med 2010;5:10 2005 P Patients at risk 9,720 11,207 Appropriate prophylaxis 58% 98% <0.001 Hospital-acquired VTE 131 92 <0.001 Preventable hospital- acquired VTE 44 7 <0.001 1 2
  • 18. Thromboprophylaxis leads to Fewer Adverse Outcomes Zeidan – Am J Hematol 2013;88:545 2.5% 1.1% 0% 0.5% 1.0% 1.5% 2.0% 2.5% Symptomatic VTE Preventable VTE Clinical Events at 90 days Major bleeding 0.7% 0% 0.3% 0.1% Pre-intervention (N=1,000) Post-intervention (N=942) • Medical patients at Johns Hopkins 2
  • 19. • QI project at King’s College Hospital launched in 2010 (aligned with national VTE program) • Development of a local VTE Prevention Program • Mandatory, documented VTE risk assessment • VTE prophylaxis guidance • Mandatory VTE education • Identification of hospital-associated VTE • Root cause analysis with targeted QI interventions Effect of a VTE Prevention Program on Hospital-Assoc VTE Roberts – Chest 2013;144:1276 3
  • 20. Patients with a VTE Risk Assessment Roberts – Chest 2013;144:1276 % of patients
  • 21. • QI project at King’s College Hospital, London, 2010-12 VTE Prevention Program Reduces Hospital-Associated VTE 2010-11 2011-12 p VTE risk assessment 63% (38-88) 93% (90-97) HA-VTE Per 1,000 admissions 236 19.7/mo 1.5 189 15.8/mo 1.0 0.014 Potentially preventable HA-VTE 43% 32% 0.005 Roberts – Chest 2013;144:1276
  • 22. • All patients admitted to all 163 NHS trusts, 2010-12 • Mandatory reporting of use of the VTE risk tool Use of the UK National VTE Risk Assessment Tool Lester – Heart – 2013;99:1734 Rate of VTE risk assessments performed [IQR] 100% 0% 50% July 2010 March 2012 51% [27,71] 93% [91,96] 4
  • 23. • All 4 million patients admitted to all 163 NHS hospital trusts >3 days, 2010-12 Hospital-Acquired Fatal VTE is Reduced in Adherent Hospitals Lester – Heart – 2013;99:1734 Fatal VTE <90 days after hospital discharge Rel Risk for hospitals with VTE risk assessment >90% vs <90% All 0.85 [0.75-0.96; p=0.01] Post-discharge 0.81 [0.67-0.79; p=0.03] Achieving >90% VTE risk assessment is associated with significant lower VTE mortality
  • 24. National VTE Mortality Data England Year VTE listed as cause of death 2007 6,121 2008 6,170 2009 6,218 2010 6,282 2011 4,562 2012 4,668 From R. Arya - Office for National Statistics, 2013
  • 25. • Why participate in the VTE audit? • What did we learn last year? • How to complete the audit • Instructions for getting your Data Collection Form Agenda
  • 26. 2013 National VTE Audit RESULTS
  • 27. • Audit April, 2013 • 118 centers, 4,667 patients, 9 provinces coast to coast • General medical and general surgical patients • Analyses conducted by CMT with data from Patient Safety Metrics (PS Metrics) 2013 VTE Audit Day
  • 28. • Overall, thromboprophylaxis use = 81% - Very good (but with room for improvement) Thromboprophylaxis Use
  • 29. Appropriate Thromboprophylaxis - by Province (2013) % of patients 100% 65%
  • 30. Types of Thromboprophylaxis • Thromboprophylaxis: • LMWH 61% • LMWH or LDH 90% • Mechanical only 4% • Variability: • By Patient Group: Medical: LMWH 70% vs LDH 21% Surgical: LMWH 45% vs LDH 46% • By province • By region within provinces
  • 31. • Overall, 19% did not receive appropriate thromboprophylaxis • Reasons: • No thromboprophylaxis 70% • Delay in start 9% • Wrong dose 8% • Modality varied from SHN recommendation 6% Reasons for not using Thromboprophylaxis
  • 32. Reasons for not using Thromboprophylaxis
  • 33. • Overall, 55% of patients had preprinted order sets • Huge differences by province (13%  63%) and region Order set use
  • 34. Impact of Preprinted Order Sets N=4,518 Order set used Order set not used 91% 71%
  • 35. 2014 National VTE Audit
  • 36. • Why participate in the VTE audit? • What did we learn last year? • How to complete the audit • Instructions for getting your Data Collection Form Agenda
  • 37. • When? – October 1 to 15, 2014* • Purpose: – Obtain a current estimate of national VTE prophylaxis rates – Increase awareness of VTE prophylaxis – Contribute to the first World Thrombosis Day on October 13, 2014 – Improve experience with the VTE Data Collection Tool and other tools available to support VTE *Data collected up to Oct. 31st will be accepted 2014 Canadian VTE Audit
  • 38. • Your commitment: – Approximately 60 minutes • Your essential contribution: – Helping to improve the delivery of safe and effective care for patients Canadian VTE Audit 2014
  • 39. • The VTE audit will again focus on: – Internal Medicine – General Surgery • Audit sample can be: – Both Medical AND General Surgical patients (preferred option) – OR, either Medical or Surgical patients Patients include
  • 40. • At least 20 patients from each group (medical, surgical) • 4 options for determining audit sample: 1. All eligible medical AND general surgical patients 2. All eligible medical OR surgical patients 3. A sample of eligible medical AND surgical patients (consecutive patients, random sample, 1 or more nursing units) 4. A sample of eligible medical OR a sample of eligible surgical patients Step 1: Identifying Audit Sample
  • 41. • Inclusion: – Patients in hospital on Oct. 1 AND with an actual or expected LOS of more than 2 calendar days – Patients admitted between Oct. 1-15* with an actual or expected LOS of more than 2 calendar days • Exclusions: – Patients in hospital >30 calendar days – Patients receiving therapeutic doses of anticoagulants *May extend to Oct. 31st if required Eligibility Criteria
  • 42. • Internal Medicine: – For example, patients admitted with: • CHF, severe respiratory disease, or confined to bed with active cancer, previous VTE, sepsis, acute neurologic disease, inflammatory bowel disease • General Surgical Patients: – All general surgical patients are eligible if they meet the general criteria for eligibility – Exclude Low risk surgical patients • Non-major surgery and fully mobile and NO additional VTE risk factors Eligibility Criteria
  • 43. • Collect data related to 4 questions: 1. Were preprinted orders used on admission or after surgery? 2. What type of thromboprophylaxis was used? 3. Did the patient receive appropriate thromboprophylaxis? 4. If no to Q3, why was recommended thromboprophylaxis not used? Steps for conducting the audit
  • 44. • Direct Chart Audit!! – Go to the patient care unit – Determine patient eligibility • Chart Review/MAR • Report from pharmacy system – Complete VTE data collection form • More to come . . . How will you collect the data?
  • 45.  Case 1: No VTE Prophylaxis was ordered – Column 1: answer NO – Column 2: select #12 “No Order” – Column 3: select NO (no appropriate thromboprophylaxis) – Column 4: select #1 “No Prophylaxis Ordered” Reviewing the chart
  • 46.  Case 2: VTE Prophylaxis has been ordered for the patient – Column 1: look at whether an order set was used to order the VTE prophylaxis • Answer YES or NO in column 1 – Column 2: select the thromboprophylaxis ordered from the list of options Reviewing the chart
  • 47.  Case 2: VTE Prophylaxis has been ordered for the patient – Column 3: decide whether the VTE prophylaxis was appropriate for the patient Reviewing the chart
  • 48. NB: All patients included in the audit sample are eligible for thromboprophylaxis • Prophylaxis is considered appropriate if: – It was started within 24 hours (1 calendar day) of admission or after surgery – Choice is according to evidence-based anticoagulant prophylaxis – Mechanical thromboprophylaxis if anticoagulant is contraindicated – patient actively bleeding or at high risk of bleeding) Determining appropriateness
  • 49.  Case 2: VTE Prophylaxis has been ordered for the patient – Column 4: if you answered NO to column 3, choose the reason(s) why the order was not appropriate Reviewing the chart
  • 50. How to participate in the VTE Audit
  • 51. 1. Use your VTE form from last years VTE Audit www.patientsafetymetrics.ca 2. Register for VTE audit day and we will create and email your data collection form http://www.saferhealthcarenow.ca/EN/events/other/VTEAudit/Pages/default.aspx 3. Register for Patient Safety Metrics and create your own Data Collection Tool. www.patientsafetymetrics.ca Refer to the detailed instructions for more information about each option. http://www.saferhealthcarenow.ca/EN/events/other/VTEAudit/Pages/default.aspx 3 options for getting your form 51
  • 52. 52 How to Request a Data Collection (Audit) Form
  • 53. Completing Audit Form Request
  • 54. Patient Safety Metrics An Overview
  • 55. Features: • Cloud-based data collection and reporting tool • User friendly and simple to navigate • Accessible from website with login details • Tracks >100 process and outcome measures over 14 interventions • Provides real time reporting. • Reduces burden of data collection, entry and analysis • Capacity to customize measures and reports Patient Safety Metrics
  • 56. • Data Collection Forms – Patient-level data (de-identified) - daily – Multiple data elements – Print form  Collect data  Fax form – Automatic roll-up to Measurement Worksheets • Measurement Worksheets – Aggregate data - monthly – Numerator and Denominator Worksheets vs Data Collection Forms
  • 57. PS Metrics can be used to support: • Small and Large Scale Improvement Initiatives • Roll Up or Drill Down Reports [e.g. Unit Site  Program Corporation Region Province  Node  National] • Produce automated run charts • Reporting for accountability • Possible to customize indicators to meet provincial, regional and local reporting needs Potential applications of the system
  • 58. Completing Audit Form - #1
  • 59. Completing Audit Form - #1 Virginia Flintoft 416-946-8350, virginia.flintoft@utoronto.ca
  • 60. Access to PS Metrics 60 https://psmetrics.utoronto.ca/metrics/login.aspx https://psmetrics.utoronto.ca/metrics/Login.aspx?language=french
  • 61. • Fax form in FINE RESOLUTION (setting on fax machine) • Use Flat-bed Fax Machines – feeder faxes produce lines • Do not write or stamp on forms except where allowed • Incorrectly Filled HCP Bubbles(pen, pencil, but Sharpie is best) Beware of Common Errors! 61
  • 62. Thank you … Questions? 62
  • 63. Poll Sondage
  • 64. Thank you! For any questions, contact: Virginia Flintoft – 416-946-8350 Artemis Diamantouros– 416-480-6100 x3654 Email: artemis.diamantouros@sunnybrook.ca

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