What use is the DAWN VTE module? UHL acute ambulatory DVT service - - PowerPoint PPT Presentation
Balmoral building level 1 between ED and radiology and the WRVS cafe What use is the DAWN VTE module? UHL acute ambulatory DVT service where are we now? M-F 8am-8pm (6:30pm last referral) Sat 8am-12am(10:30am last referral)
jane.strong@uhl-tr.nhs.uk
Balmoral building level 1 between ED and radiology and the WRVS cafe M-F 8am-8pm (6:30pm last referral) Sat 8am-12am(10:30am last referral)
Process, Role and Responsibilities
Treatment first time
Improving Health Improving Health Best Possible Care Best Possible Care Joy and Pride in Work Joy and Pride in Work Value for Money Value for Money
Service Vision Service Vision DVT/PE/Anticoagulation Service – One Service – One Team Step opportunity for improvement Approach and principles moving forward
Prescribe Inject Prescribe Inject Assess Assess Wells Score Wells Score Scan Scan Blood Test Blood Test
Level 1
DVT Service – One Service – One Team
Unlikely Likely Low High
+ve 2 weeks To 3 Months
Level 2 Level 3 85% 20%
NICE CG144/TA261/TA327/TA341
and GP communication
governance and audit trail
Design a DVT module
Background: University Hospitals of Leicester acute ambulatory DVT service assesses 3,000 patients a year and treats 600 new DVTs. Service improvements were required to optimise administrative
DVT nursing team from delivering a very busy clinical service and making audit difficult. Aims: We wanted to create an electronic DVT record within the same system as the computer aided anticoagulant dosing software. The vision of a paperless DVT module (assessment, diagnosis, treatment and follow up) with seamless referrals and communication with anticoagulation and primary care was born. Methods: The whole DVT pathway has been sequentially computerised and tested within the clinical environment. Results: The module first went live in August 2013.Between August 2013 and December 2014 we have assessed 4248 patients using the module; 675 (16%) were assessed as DVT unlikely with Wells score and d dimers and did not proceed to scan, 3426 had scans of which 754 DVTs (22%) and 147 cases of thrombophlebitis were diagnosed. Rivaroxaban became first line treatment for first DVTs in our service in October 2014 – a rivaroxaban treatment module captures the assessment, treatment and follow up of these patients – 100 to date. All primary care physician letters are generated within the system and sent electronically when possible .Conclusion: Implementation of the DVT electronic tool and record has standardised and recorded each part of the patient pathway facilitating audit, lean accountable practice and continuous improvement in workflow efficiency, quality and
benchmarking and research. Keywords: DVT, assessment, diagnosis, lean
An electronic tool and record for deep vein thrombosis (DVT) assessment, diagnosis, treatment and follow up. J Strong, V Frimpong, J Eggleston, D Thornton, H Briggs, T Stewart, R Clarke-Drury, K Coultas, A Stewart, G Kitching, S Stewart
‘In the nineteenth century health was transformed by clear clean water. In the twenty first century, health will be transformed by clean, clear
Outcome Treatment Count Superficial Thrombophlebitis - 3 months anticoag LMWH (Dalteparin) 10 Superficial Thrombophlebitis - 3 months anticoag LMWH + warfarin 20 Superficial Thrombophlebitis - 3 months anticoag Rivaroxaban 30 Superficial Thrombophlebitis - 6 wks anticoag LMWH (Dalteparin) 121 Superficial Thrombophlebitis - 6 wks anticoag LMWH + warfarin 6 Superficial Thrombophlebitis - 6 wks anticoag Rivaroxaban 51 Superficial Thrombophlebitis requiring NSAIDs NSAIDs 48
Indication AgeBand Renalfunction Count Distal DVT - isolated calf <=50 Mild impairment 3 Distal DVT - isolated calf <=50 Normal 16 Distal DVT - isolated calf <=70 Mild impairment 6 Distal DVT - isolated calf <=70 Normal 9 Distal DVT - isolated calf <=70 Severe impairment 1 Distal DVT - isolated calf >70 Normal 2 Distal DVT - isolated calf >70 Severe impairment 2 Distal DVT in calf muscle <=50 Mild impairment 1 Distal DVT in calf muscle <=50 Normal 13 Distal DVT in calf muscle <=70 Mild impairment 4 Distal DVT in calf muscle <=70 Normal 11 Distal DVT in calf muscle <=70 Severe impairment 1 Distal DVT in calf muscle >70 Mild impairment 1 Distal DVT in calf muscle >70 Normal 3 Distal DVT in calf muscle >70 Severe impairment 5 DVT - PROVOKED <=50 Mild impairment 5 DVT - PROVOKED <=50 Normal 26 DVT - PROVOKED <=70 Mild impairment 8 DVT - PROVOKED <=70 Normal 28 DVT - PROVOKED <=70 Severe impairment 1 DVT - PROVOKED >70 Mild impairment 9 DVT - PROVOKED >70 Normal 1 DVT - PROVOKED >70 Severe impairment 7 DVT - UNPROVOKED <=50 Mild impairment 3 DVT - UNPROVOKED <=50 Normal 16 DVT - UNPROVOKED <=70 Mild impairment 9 DVT - UNPROVOKED <=70 Normal 25 DVT - UNPROVOKED >70 Mild impairment 27 DVT - UNPROVOKED >70 Normal 13 DVT - UNPROVOKED >70 Severe impairment 16 Proximal DVT - cancer provoked <=50 Mild impairment 1 Proximal DVT - reversible provoking factor <=50 Normal 7 Proximal DVT - reversible provoking factor <=70 Mild impairment 4 Proximal DVT - reversible provoking factor <=70 Normal 11 Proximal DVT - reversible provoking factor <=70 Severe impairment 1 Proximal DVT - reversible provoking factor >70 Mild impairment 5 Proximal DVT - reversible provoking factor >70 Normal 6 Proximal DVT - reversible provoking factor >70 Severe impairment 2 Proximal DVT - unprovoked <=50 Normal 3 Proximal DVT - unprovoked <=70 Mild impairment 2 Proximal DVT - unprovoked <=70 Normal 7 Proximal DVT - unprovoked <=70 Severe impairment 1 Proximal DVT - unprovoked >70 Mild impairment 9 Proximal DVT - unprovoked >70 Normal 1 Proximal DVT - unprovoked >70 Severe impairment 3 Superficial Thrombophlebitis <=50 Normal 1 Superficial Thrombophlebitis <=70 Mild impairment 1 Superficial Thrombophlebitis - 3 months anticoag <=50 Normal 9 Superficial Thrombophlebitis - 3 months anticoag <=70 Mild impairment 1 Superficial Thrombophlebitis - 3 months anticoag <=70 Normal 7 Superficial Thrombophlebitis - 3 months anticoag >70 Mild impairment 6 Superficial Thrombophlebitis - 3 months anticoag >70 Normal 5 Superficial Thrombophlebitis - 6 wks anticoag <=50 Mild impairment 1 Superficial Thrombophlebitis - 6 wks anticoag <=50 Normal 8 Superficial Thrombophlebitis - 6 wks anticoag <=70 Mild impairment 9 Superficial Thrombophlebitis - 6 wks anticoag <=70 Normal 13 Superficial Thrombophlebitis - 6 wks anticoag >70 Mild impairment 6 Superficial Thrombophlebitis - 6 wks anticoag >70 Normal 3 Superficial Thrombophlebitis - 6 wks anticoag >70 Severe impairment 2 Superficial Thrombophlebitis requiring NSAIDs <=50 Normal 1 Drive quality, value for money, equity of care
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