VTE- Making a difference on Oak Ward

Dartford and Gravesham NHS Trust

Authors: Sadie Hafford, Diabetes and HIV Specialist Midwife, and Polly Hird, Senior Sister Gastroenterology Ward

The combined efforts of nurses and doctors on Oak ward formulated a fundamental change in VTE risk assessment on the ward. This ward has shown clinical leadership for the rest of the Trust as good practice is shared.

Leadership and Teamwork

The Safety Thermometer was formally introduced to Dartford and Gravesham NHS Trust in April 2012 with the aim to start at 25% ward base and increase to 100% across the acute hospital setting by January 2013. Initially 5 wards were visited and data collected from nursing documents, prescription sheets, conversations with patients and a review of clinical documentation. This data was collected by a small team of nurses and midwives including the Safety Thermometer Coordinator.

Strategic team Ward-led team
Director of Nursing
Medical Director
General Managers
Safety Thermometer Coordinator
Clnical Haematology Teams
Clinical Nurse Specialists

Creating and Integrating a Plan

The fundamental findings highlighted a reduction in written documentation and completion of the Thromboprophylaxis Assessment Tool. However, good practise of prescribing VTE prophylaxsis was clearly evident. Within this data collection, other harms such as pressure sores, falls and catheters were documented as relatively stable. Results were given straight back to the ward sisters for feedback and analysis, enabling them to act on these findings.

Planning SMART objectives
In May 2012, other wards were including in data collection representing 47% of inpatients. Ward sisters became more aware of safety thermometer and its impact on the patients in order to highlight and reduce patient harms.
Specific: Improve VTE Risk assessment documentation on Oak Ward
Measurable: Show 100% compliance
Achievable: All inpatients to have documented risk assessment on Oak Ward
Relevant: Involve all the team
Timebound: Within 3 months

Implementing the Plan

Following results on lack of VTE assessments performed in April and May, one ward sister in particular, Polly Hird, challenged the medical team whilst data was being collected. Discussions then ensued as to how the Senior Medical Registrar may facilitate a learning programme for junior doctors. This was to incorporate both VTE assessment and prescription of prophylaxsis at the time of clerking. Polly adapted the white board to clearly document when this process had been performed enabling a visual indicator for both nursing and medical staff alike.

Implementation - Assessment and Diagnosis Implementing and Planning
Will this benefit patients?
What intervention is needed to keep our patients safe?
What prevents the completion of the VTE risk assessment?
How can we improve our practice?

Measuring and Results

The June data collection represented 74.9% of all inpatients. New drug charts were being introduced throughout the Trust incorporating a VTE risk assessment within the chart as opposed to a previous separate sheet manually attached to the drug chart. A change in documentation has improved VTE assessment across the hospital site. However Polly has gained 100% in both assessment and prescribing of VTE prophylaxsis consistently. This has clearly demonstrated how leadership, teamwork and communication across multidisciplinary areas can facilitate a reduction in harms to patients.

Spreading the Message

By July 2012, 100% of data collection has been established involving more ward sisters eager to improve ‘Harm Free’ care to patients within their ward environment. Regular ‘Harm Free Care’ presentations are given to staff highlighting areas for improvement and simultaneously raising awareness of the harms.