Introduction

Venous Thromboembolism (VTE) is a leading and potentially preventable cause of death in hospitalised patients.

It has been estimated that up to 25000 people in the UK die from hospital associated VTE each year, many if not most of which could be prevented by the use of appropriate thromboprophylaxis as indicated by the outcome of a detailed thrombosis risk assessment performed on admission and reassessed after 24 hours and as appropriate throughout the admission. A UK survey carried out in 2005, suggested that 71% of patients assessed to be at medium or high risk of developing deep vein thrombosis (DVT) did not receive any form of mechanical or chemical thromboprophylaxis.

VTE, spontaneous or precipitated, can occur in any individual. The incidence increases with age and with numerous recognised risk factors including: hospitalisation for any reason; prolonged immobility; dehydration; oestrogen containing hormonal treatment and malignancy. The presence of an underlying thrombophilia (inherited or acquired) will increase baseline risk further.

VTE encompasses a range of clinical presentations and is often asymptomatic. There is a considerable burden of mortality and morbidity associated with VTE, including: venous insufficiency; post thrombotic limb/syndrome; pulmonary hypertension.

This policy seeks to enable healthcare practitioners at ASPH to identify patients at risk of developing VTE and select appropriate preventative treatment to reduce the mortality and morbidity associated with this disease.

 

Purpose

The purpose of this policy is to establish the principles and practice of a high quality approach to VTE prevention throughout the Trust which meets the requirements of NICE guidance (CG92) and NICE quality standards as well as local and internal quality schedules. This will be achieved through:

  • The use of risk assessment using the locally developed thrombosis risk assessment tool incorporating guidance from the National VTE assessment tool, with risk assessment undertaken on admission, 24 hours post admission and as indicated by a changing clinical picture
  • The subsequent prescribing of thromboprophylaxis appropriate to outcome
  • Audit of compliance with risk assessment and appropriateness of thromboprophylactic prescribing
  • Root cause analysis of all confirmed cases of hospital associated thrombosis
  • Education of patients/carers through the use of the locally developed patient information leaflet incorporating pre-admission, admission and post discharge advice with verbal re-enforcement.
  • Education of staff as part of on-going and mandatory training.

 

Policy Details

Download: PDF version
Compiled by: Rebecca Bushby, VTE Prevention Nurse Specialist
Ratified by: Thrombosis Committee, Drugs and Therapeutics Committee
Date Ratified: October 2016
Date Issued: October 2016
Review Date: October 2018
Target Audience: All staff
Contact name: Rebecca Bushby, VTE Prevention Nurse Specialist

 

See also:

  • NICE Guideline CG92
  • NICE Quality Standard QS3
  • Venous Thromboembolism: Management of pregnant and Postnatal Women at Increased Risk