Venous thromoembolism (VTE) is a major patient safety issue for hospitals. Preventative measures should be implemented to reduce its associated morbidity and mortality.
Last June, one of the first ever quality standards developed by the National Institute for Clinical Excellence (2010b) identified specific measureable outcomes related to VTE prevention. These standards included ensuring that all patients on admission receive an assessment of VTE and bleeding risk and appropriate thromboprophylaxis.
A main aim of the Equity and Excellence: Liberating the NHS white paper is to improve safety, effectiveness and patient experience. The priorities for the health service in the next two years are set out in the operating framework for the NHS in England. Preventing VTE features in both these documents, and the national Commissioning for Quality and Innovation VTE goal will also be included for 2011-12 in acute CQUIN schemes. The current target requires that at least 90% of all hospitalised patients are risk assessed for VTE on admission - it recommends thromboprophylaxis rates are audited and all cases of hospital associated thrombosis are subject to root cause analysis.
I welcome this national focus on prevention of VTE as it encourages evidence based care through the use of the Department of Health’s national VTE risk assessment tool and clinical guidelines on appropriate thromboprophylaxis for all hospitalised patients (NICE, 2010a).
There are 18 VTE exemplar centres nationally that can share ideas and resources; every single clinician who cares for a hospitalised patient needs to become responsible for adopting exemplar practice.
Nurses have an essential role in VTE prevention. The VTE link nurse role is evolving; the aim is that each clinical area has a nominated link to its local thrombosis team. This enables link nurses to disseminate information, training and resources to their colleagues. In many areas nurses are conducting VTE risk assessments.
Nurses should be competent on how to assess patients for indications, contra-indications and the correct administration of thromboprophylaxis modalities. VTE prevention needs to become part of the nursing process of assessing, planning, implementing and evaluating care.
The National Nursing and Midwifery Network (NNMN) provides leadership and encourages innovative strategies to prevent VTE. Outcomes from VTE work streams relating to education, audit, research, communication, clinical practice and midwifery will available via the national VTE exemplar centre website: www.kingsthrombosiscentre.org.uk (select the Nursing, Midwifery and Pharmacy tab).
Lynda Bonner is a consultant nurse for Thrombosis and Anticoagulation at King’s College Hospital FT. Email email@example.com information on the NNMN
National Institute for Clinical Excellence (2010a) Clinical Guideline 92 Venous thromboembolism - reducing the risk. 16 February.
National Institute for Clinical Excellence (2010b) VTE Prevention Quality Standard. 1 June