In detail: how Kettering tackled VTE

The prevention of venous thromboembolism is a major safety priority within the NHS. The health service has an integrated and financially incentivised approach to deliver this most important patient safety issue. The short term challenge for Kettering General Hospital Foundation Trust in 2010 was how to meet the national commissioning for quality and innovation (CQUIN) goal of at least 90 per cent of adult patients assessed for VTE risk.

The further requirements of the VTE prevention programme, including the need to perform root cause analysis of each hospital-associated incident, shows the need for effective, long term solutions to meet the challenge of VTE prevention at the trust.    

To help us accomplish the challenging task of documenting risk assessment of at least 90 per cent of all inpatients we approached Sanofi, the suppliers of our existing low molecular weight heparin. Sanofi was able to provide dedicated time and resources that we could not, and some of their staff became closely integrated with our team.

By understanding our specific needs, Sanofi was able to identify opportunities to develop tailored solutions to achieving the CQUIN goal. the trust identified four key areas in which Sanofi could help the most, and together we developed an implementation plan to achieve the target.

1 VTE structure

Although we had a thromboprohylaxis committee in place, it was clear there was a need to identify VTE champions to create a link between the committee and the staff on the ground – the ward and link nurses, and the junior doctors – to bring the vision and actions required to achieve our goal. A Sanofi staff member was granted an honorary contract and became integrated into Kettering’s thromboprophylaxis committee, taking the committee’s best practice and solutions out to the wards and being an effective champion for training, awareness and implementation of VTE prevention.

2 VTE training

One of the main focuses of our strategy was to increase VTE awareness via educational initiatives. Policies and procedures were written through our thromboprophylaxis committee, however dissemination of consistent messages remained a problem as there was no resources to facilitate. We received support for our link nurse network, with regular meetings and places on specialist training courses. Sanofi supported our mandatory clinical skills update training meetings, and regularly supported our junior doctor training meetings.

The key clinical pharmacy staff also performed the necessary continuing professional development via the venous thromboembolism Learning@lunch module. Other resources are also available including an online networking portal and CPD programme for clinical pharmacists, developed in association with the UK Clinical Pharmacy Association and Keele University’s school of pharmacy - www.linkupvte.com.

3 VTE systems and tools

Sanofi helped Kettering to develop documentation for our link nurses and junior doctors, which helped to raise awareness of VTE and ensure correct prescribing and optimal administration technique. Low molecular weight heparin dosing posters and complementary dosing cards are used throughout the hospital. Our VTE audit project – a monthly ward audit to capture risk assessment and prescribing information – was improved by Sanofi’s knowledge of best practice from other trusts with better design of the audit proforma and associated documentation. Our partnership helped us improve our VTE risk assessment materials; in liaison with the thromboprophylaxis committee, Sanofi helped us revise our risk assessment tools and to develop risk assessment stickers for obstetrics and gynaecology patients.  

4 VTE communications

During 2010 Sanofi’s continued support helped maintain the profile of the audit project, keeping it fresh in the minds of the junior doctors, and has been instrumental in disseminating the results, which has encouraged us to celebrate success and learn from any issues identified.

We have tackled resistance to the increased focus on VTE via the educational initiatives detailed above, and by improving the visibility of the thromboprophylaxis committee. We have developed incentives and rewards for junior doctors in return for their involvement in the audit project.

The support provided by Sanofi to the link nurse network has helped ensure hands-on involvement from these staff; the opportunity to achieve link nurse status as part of a formal career development path has been a major incentive to become involved.

Scott Savage is chief pharmacist at Kettering General Hospital Foundation Trust