ࡱ>   bjbj 44   ^^8tD**(RRR!!!oqqqqqq$$i!!"!!!^^RR&&&!^8RRo&!o&&muR`Dt)#!pL[0Dmp8ʸ2%ʸuu&ʸu;!!&!!!!!&!!!D!!!!ʸ!!!!!!!!!  $:  FREEDOM OF INFORMATION REQUEST  FOI request into Trust Venous Thromboembolism (VTE) prevention and management practices Name: Dr Chris Gregory Position: Consultant Haematologist Acute Trust: WWL NHS Foundation Trust Email: chris.gregory@wwl.nhs.uk Venous thromboembolism (VTE) is a collective term referring to deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is defined by the following ICD-10 codes: I80.0-I80.3, I80.8-I80.9, I82.9, O22.2 O22.3, O87.0 O87.1, I26.0, and I26.9. QUESTION ONE  VTE RISK ASSESSMENT AND DIAGNOSIS Are in-patients who are considered to be at risk of VTE in your Trust routinely checked for both proximal and distal DVT? (Tick one box) Yes&No( For in-patients diagnosed with VTE in your Trust between 1 April 2017 and 31 March 2018, what was the average time from first clinical suspicion of VTE to diagnosis? Less than 4 hours  For in-patients diagnosed with VTE in your Trust between 1 April 2017 and 31 March 2018, what was the average time from diagnosis to first treatment? Most had already been started on treatment prior to a scan confirming a clot. Some patients had a CT scan for a different reason and a clot was picked up incidentally. These patients had treatment started within a few hours of the scan results being known.  QUESTION TWO ROOT CAUSE ANALYSIS OF HOSPITAL-ASSOCIATED THROMBOSIS According to Service Condition 22 of the NHS Standard Contract 2017/19, the provider must: Perform Root Cause Analysis of all confirmed cases of pulmonary embolism and deep vein thrombosis acquired by Service Users while in hospital (both arising during a current hospital stay and where there is a history of hospital admission within the last 3 months, but not in respect of Service Users admitted to hospital with a confirmed venous thromboembolism but no history of an admission to hospital within the previous 3 months)... The provider must report the results of those Root Cause Analyses to the co-ordinating commissioner on a monthly basis. How many cases of hospital-associated thrombosis (HAT) were recorded in your Trust in each of the following quarters? Quarter Total recorded number of HAT 2017 Q2 (Apr Jun) 6 2017 Q3 (Jul Sep) 20 2017 Q4 (Oct Dec) 10 2018 Q1 (Jan Mar) 17 How many Root Cause Analyses of confirmed cases of HAT were performed in each of the following quarters? Quarter Number of Root Cause Analyses performed 2017 Q2 (Apr Jun) 10 2017 Q3 (Jul Sep) 14 2017 Q4 (Oct Dec) 13 2018 Q1 (Jan Mar) 13 We do not ask for Root Cause Analyses (RCAs) until patients have been discharged which could often be in a different month or quarter. Therefore there is always a lag between Hospital-associated Thrombosis (HATs) identified and Root Cause Analyses (RCAs) completed. According to the Root Cause Analyses of confirmed HAT in your Trust between 1 April 2017 and 31 March 2018, in how many cases: Did patients have distal DVT?1Did patients have proximal DVT?8Were patients not receiving thromboprophylaxis prior to the episode of HAT?5 (all had a documented reason why)Did HAT occur in surgical patients?26Did HAT occur in general medicine patients?26Did HAT occur in cancer patients?13 QUESTION THREE ADMISSION TO HOSPITAL FOR VTE How many patients were admitted to your Trust for VTE which occurred outside of a secondary care setting between 1 April 2017 and 31 March 2018? 232  Of these patients, how many: Had a previous inpatient stay in your Trust up to 90 days prior to their admission?1Were care home residents?Data not routinely collectedWere female?132Were male?100Were not native English speakers?5Were from a minority ethnic group?5 Of the patients admitted to your Trust for VTE occurring between 1 April 2017 and 31 March 2018 who had a previous inpatient stay in your Trust up to 90 days prior to their admission, how many had their VTE risk status recorded in their discharge summary? 0  Please describe how your Trust displays a patients VTE risk status in its discharge summaries. If a patient is discharged on prophylactic anticoagulation then the GP letter contains the name, dose and duration of the medicine required. The patient would also be discharged with a supply of the anticoagulation to last until the course was intended to finish. If a patient is not considered to be at an ongoing risk of VTE nothing extra is added to the discharge summary. QUESTION FOUR INCENTIVES AND SANCTIONS Has your Trust received any sanctions, verbal or written warnings from your local commissioning body between 1 April 2017 and 31 March 2018 for failure to comply with the national obligation to perform Root Cause Analyses of all confirmed cases of HAT? (Tick one box) Yes If yes, please detail the level of sanction or type of warning received: &No( The NHS Standard Contract 2017/19 sets a National Quality Requirement for 95 per cent of inpatient service users to be risk assessed for VTE. Between 1 April 2017 and 31 March 2018, has your Trust received any sanctions, verbal or written warnings from your local commissioning body for failing to deliver the minimal VTE risk assessment threshold? (Tick one box) Yes If yes, please detail the level of sanction or type of warning received: Verbal and written concerns raised. However the issue was not with compliance, but rather data gathering when we switched from paper to electronic systems. This issue has now been resolved.( No & QUESTION FIVE  PATIENT INFORMATION The NICE Quality Standard on VTE Prevention stipulates that patients/carers should be offered verbal and written information on VTE prevention as part of the admission as well as the discharge processes. What steps does your Trust take to ensure patients are adequately informed about VTE prevention? 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(Tick each box that applies) Yes If yes, please specify which languages: The leaflets are all in English as standard, but if there is a need for interpretation into another language this is done case by case on request.( No & END THANK YOU FOR YOUR RESPONSE Anticoagulation UK is the secretariat for the All Party Parliamentary Thrombosis Group. They employ Four Communications from grants received from the BMS - Pfizer Alliance and Bayer.     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