Peter Davies
Senior Pharmacist

Venous thromboembolic prevention is a DH
patient safety priority

NICE clinical guideline venous thromboembolism
reducing the risk

CQUIN

The NHS standard contract for acute services
and VTE prevention

VTE risk assessment audit

Clinical incident/Pharmacy intervention
monitoring

Healthcare record audit

Root cause analysis of hospital
acquired thrombosis

Rivaroxaban use in elective THR and TKR

Audit data since June 2008

Data collected from the front of the drug
administration and record chart

3 monthly data until May 2010 now monthly

CQUIN requirements
VTE risk assessment at Salisbury Hospital 2008-2010
100
90
Percentage (%) risk assessed
80
70
60
50
40
30
20
10
0

Reporting forms adapted to include fields to
record incidents and interventions relating to
VTE prevention and prophylaxis

Report generated by clinical risk and sent
monthly to the thrombosis committee

Data provided by individual wards

Audit of 5 sets of healthcare records

Record data on whether risk assessment and
thromboprophylaxis is appropriate on an
electronic data collection form

Data collated by clinical audit and forwarded
to the Thrombosis committee

Hospital acquired thrombosis detected by
DVT/Anticoagulant clinic
Coding
Diagnostics
Autopsies

Subjected to a root cause analysis

Reviewed by the Thrombosis committee

For elective Primary THR or TKR

First dose 30 hours post surgery

14 days for TKR and 35 days for THR

Contra-indicated e-GFR <30ml/min

Not used if on long term anticoagulant
Documented bleeding episodes resulting in
rivaroxaban being stopped/omitted
Wound oozing/bleeding
Number
of
episodes
4
GI bleed
2
Haematuria in catheterised patient
1
Bleed from drain
2
Off-label use of rivaroxaban
Number of
patients
Revision of TKR
3
Revision of THR
3
Patella resurfacing
2
Hip resurfacing
2
Uni-compartment knee replacement
2
Fractured neck of Femur leading to THR
1