{
  "abstract": "Background NICE guidelines recommend all medical admissions should have a VTE risk assessment (RA) (National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. [NG89] [Last updated 2019 Aug 13]).In palliative care, VTE prophylaxis with low molecular weight heparin should be considered unless in the last days of life (NICE. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. [NG89]). The ‘HIDDen’ study found that 1/3 of persons receiving care in specialist palliative care settings with advanced cancer had femoral DVT (White, Noble, Watson, et al. Lancet Haematol. 2019;6(2):e79-e88).Aim To increase compliance with documenting VTE RA to 100% by 06/01/2025.Methods Data was collected weekly from 24/10/24-02/01/25. Process measures included compliance with completing VTE RA sections of the initial clerking and drug charts and doctors’ subjective confidence rating. Outcome measures were number of patients prescribed VTE prophylaxis and patient views on the impact on quality of life (QoL) (Cimminiello, Anderson. Thromb Res. 2012;129(2):139-45; Apenteng, Fitzmaurice, Litchfield, et al. BMJ Open. 2016 Dec 13;6(12):e013839). The balancing measure was time taken to complete VTE RA. Fishbone/driver diagrams were used to understand underlying problems (low prescriber confidence and lack of robust decision-making framework) and identify solutions (education, updating the VTE RA section in the clerking document, adding a prompt to the handover document, twice weekly formal review and daily informal review).Results Compliance with documenting VTE RA in drug charts after intervention remained around 93% but improvement was demonstrated in initial clerking documentation from 71% to 93%. The frequency of patients receiving VTE prophylaxis (0-1) each week remained constant and doctors’ confidence with completing VTE RA improved from an average of 5/10 to 9/10 after implementing change. Of seven patients who previously had injected VTE prophylaxis and completed the QoL questionnaire, five would have been happy to have it again. Doctors felt that implemented change did not affect the time taken to complete/document VTE RA decisions.Conclusion This project demonstrates that improved clinical practice can be achieved using quality improvement methodology and the need for a standardised, evidence-based clinical decision tool for VTE RA in specialist palliative care settings.",
  "authors": [
    {
      "affiliations": [
        "Saint Francis Hospice, Romford, UK"
      ],
      "name": "Ruth Porther"
    }
  ],
  "title": "P-64 Improving VTE risk assessment in a hospice setting: implementing qi methodology",
  "uid": "bc3acba5-4991-50da-9d1c-a2022f2562cc"
}