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Catch up on previous Maternity & Newborn Safety Investigations (MNSI) webinars and view slides from the presentations. Webinars and slide topics: Think beyond sepsis Sudden Unexplained Death in Epilepsy (SUDEP) First trimester deaths in England from venous thromboembolism associated with hyperemesis Maternal death from pulmonary embolism -
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untilThe Maternity and Newborn Safety Investigations (MNSI) programme is part of a national strategy to improve maternity safety across the NHS in England. MNSI has completed over 3500 independent safety investigations, using system focused methodology, into maternity events, including direct and indirect maternal deaths in pregnancy and up to 6 weeks postpartum. This webinar will explore the findings from MNSI's investigations into first trimester deaths in England from venous thromboembolism associated with hyperemesis. Speakers: Dr Charlotte Frise Dr Louise Page Chandrima Biswas Kirsty MacLennan Register for the webinar- Posted
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Compression stockings might be unnecessary for patients at moderate or high risk of blood clots who are undergoing planned surgery. A study called GAPS suggests that anti-clotting medicine alone is just as effective as using it in combination with compression stockings. Researchers involved in the large randomised controlled study recommend that guidelines for preventing blood clots such as deep vein thrombosis (DVT) and pulmonary embolism (PE) should be changed. They suggest that compression stockings should no longer be standard care for most patients having planned surgery and taking anti-clotting medicine while in hospital. This could save the NHS in England around £63 million per year.- Posted
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Top picks: Venous thromboembolism
Patient Safety Learning posted an article in High risk areas
Blood clots, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE), together venous thromboembolism (VTE), pose a significant health threat to patients. These potentially life-threatening conditions can manifest silently and without warning, making vigilance and knowledge crucial. In this Top picks, we’ve pulled together resources, blogs and reports from the hub for patients and healthcare professionals, which focus on how to recognise venous thromboembolism and how to improve patient safety. 1. Deep vein thrombosis: understanding and managing your risk In this blog, Jo Jerrome, CEO of Thrombosis UK, explains the dangers of DVT and why it is important for patients and staff to be aware of the risk factors. Jo offers advice on how we can all manage our risk of DVT. 2. HSIB - Clinical decision making: diagnosis of pulmonary embolism in emergency departments This investigation by the Healthcare Safety Investigation Branch (HSIB) explores the timely recognition and treatment of suspected pulmonary embolism in emergency departments. 3. Jenny, and why we must learn from her misdiagnosis of pulmonary embolism Jenny Edwards died in February 2022 from pulmonary embolism, following misdiagnosis. In this blog, her son Tim introduces us to Jenny, illustrating the deep loss felt following her premature passing. He talks about the care she received and argues that there were multiple points at which pulmonary embolism should have been suspected. 4. Venous thromboembolism (VTE): deep vein thrombosis and pulmonary embolism VTE is a significant cause of mortality, long-term disability and long-lasting ill-health problems – many of which are avoidable. 1 in 20 people will have a VTE at some time in their life and the risk increases with age. This NHS Resolution guide provides more information about the risks of VTE and how to spot the common signs and symptoms. 5. HSIB - The assessment of venous thromboembolism risks associated with pregnancy and the postnatal period final report This investigation by the HSIB explores the issues associated with the assessment of risk factors for venous thrombosis in pregnancy and the first six weeks after birth. 6. NHS Resolution: Working to prevent avoidable venous thromboembolism VTE is an international patient safety issue and a clinical priority for the NHS. Around half of all cases of VTE are associated with hospitalisation, with many events occurring up to 90 days after admission. It is a leading and preventable cause of death in an estimated 25,000 of hospitalised patients each year. This information leaflet highlights the cost of VTE claims and what you can do in your organisation to prevent VTE. 7. Pulmonary embolism misdiagnosis – a systemic problem Tim Edwards is a risk management expert and son of Jenny, who passed away in February 2022 from pulmonary embolism, following a misdiagnosis. Frustrated by the quality of the initial investigation that followed her death and the lack of assurance that learning would take place, Tim conducted an independent review. In this opinion piece, Tim draws on his research to highlight the key patient safety issues, and to encourage further dialogue around the topic. 8. Let's Talk Clots! Help reduce your risk of DVT and PE in hospital with this simple app Download the free Let’s Talk Clots patient information app from Thrombosis UK, and help reduce your risk of DVT and pulmonary embolism in hospital. 9. Patient Safety Spotlight Interview with Beverley Hunt, Professor of Thrombosis and Haemostasis and founder of Thrombosis UK In this interview, Beverley Hunt talks about setting up Thrombosis UK and how it has grown to have a national impact on patient safety in hospitals. She also describes the value of combining policy work with seeing patients face-to-face, and explores the need to find new ways of working to deal with the pressures facing the healthcare system. 10. Risk assessment models for venous thromboembolism in medical inpatients This cohort study in JAMA Network Open aimed to determine the prognostic performance of the simplified Geneva score and other validated risk assessment models (RAMs) to predict VTE in medical inpatients. The study provided a head-to-head comparison of validated RAMs among 1352 medical inpatients. It found that sensitivity of RAMs to predict 90-day VTE ranged from 39.3% to 82.1% and specificity of RAMs ranged from 34.3% to 70.4%. The authors concluded that the clinical usefulness of existing RAMs is questionable, highlighting the need for more accurate VTE prediction strategies. 11. HSIB: Investigation into management of venous thromboembolism risk in patients following thrombolysis for an acute stroke This HSIB investigation focused on the management of VTE risk in inpatients following thrombolysis for an acute stroke detection of medical problems (that impact on VTE risk) occurring in inpatients following thrombolysis for an acute stroke. Do you have a resource or story to share? We’d love to hear about it - leave a comment below or join the hub to share your own post.- Posted
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Better use of data for medication safety in hospitals
Kenny Fraser posted a topic in Medicine management
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NHS hospital staff spend countless hours capturing data in electronic prescribing and medicines administration systems. Yet that data remains difficult to access and use to support patient care. This is a tremendous opportunity to improve patient safety, drive efficiencies and save time for frontline staff. I have just published a post about this challenge and Triscribe's solution. I would love to hear any comments or feedback on the topic... How could we use this information better? What are hospitals already doing? Where are the gaps? Thanks- Posted
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Content Article
Safety thermometer tool (NEQOS)
Patient-Safety-Learning posted an article in Quality Improvement
The aim of the NHS Safety Thermometer is to provide a local improvement tool for measuring, monitoring and analysing patient harms and ‘harm free care’. Data is collected by Trusts on pressure ulcers, falls, urinary tract infections (UTI), and Venous Thromboembolism (VTE) assessments, prophylaxis and treatment. The North East Quality Observatory Service (NEQOS) Safety Thermometer Tool allows trusts to compare themselves against their peers (for improvement purposes) as well as to undertake internal comparisons across different service areas within the Trust. Produced quarterly, the tool uses National Safety Thermometer data published by NHS Digital and presents this by Trust across the North East & North Cumbria (NENC) area, providing comparisons between peers as well as with the national average, with breakdowns by service areas for detailed analysis.- Posted
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On Nov 7 2023, NHS Resolution’s Safety and Learning team, hosted a virtual forum on learning from venous thromboembolism (VTE) claims in primary care. The purpose was to raise awareness of the cost and scale of harm, discuss the challenges and recommendations around recognition and treatment of VTE in general practice. We heard from a range of experts in the field with experience in developing and spreading best practice.- Posted
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Did you know venous thromboembolism (VTE), is an umbrella term for deep vein thrombosis and pulmonary embolism? VTE is a significant cause of mortality, long-term disability and long-lasting ill-health problems – many of which are avoidable. 1 in 20 people will have a VTE at some time in their life and the risk increases with age. This NHS Resolution guide provides more information about the risks of VTE and how to spot the common signs and symptoms. Read the guide via the link below -
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This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Beverley talks to us about setting up Thrombosis UK and how it has grown to have a national impact on patient safety in hospitals. She also describes the value of combining policy work with seeing patients face-to-face, and explores the need to find new ways of working to deal with the pressures facing the healthcare system.- Posted
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Venous thromboembolism (VTE) is an international patient safety issue and a clinical priority for the NHS. Around half of all cases of VTE are associated with hospitalisation, with many events occurring up to 90 days after admission. It is a leading and preventable cause of death in an estimated 25,000 of hospitalised patients each year. -
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This Healthcare Safety Investigation Branch (HSIB) investigation focused on: the management of VTE risk in inpatients following thrombolysis for an acute stroke detection of medical problems (that impact on VTE risk) occurring in inpatients following thrombolysis for an acute stroke. HSIB makes the following safety recommendation: It is recommended that the Intercollegiate Stroke Working Party with support from the Joint Stroke Medicine Committee and NHS England and NHS Improvement develop a stroke specific venous thromboembolism (VTE) assessment tool and system for ordering the associated treatment for patients who have suffered a stroke. HSIB recommend that the Intercollegiate Stroke Working Party supports development of a tool that ensures that important information is recorded and reviewed at appropriate intervals. The following points should be considered in the development of this tool: • The aetiology/type of stroke (ischaemic and haemorrhagic). • A record of the individual risk factors for VTE that are identified. • Contraindications for VTE treatment measures. • The VTE preventative treatment recommendation. • The record of administration of that treatment. • The reason that treatment is not administered. • Patient’s level of mobility and activity (in relation to IPC administration). • Frequency of IPC devices checking. • Record of patient’s consent and understanding of risk/benefits of intervention, including patient’s decision.- Posted
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A significant fall in maternal death due to Venousthromboembolisation (VTE) followed the publication of the Royal College of Obstetricians and Gynaecologists guideline ‘Thromboprophylaxis’ in 2004. It is likely that the fall in deaths is the result of better recognition of at-risk women and widespread thromboprophylaxis. All women should undergo a documented assessment of risk factors for VTE in early pregnancy or before pregnancy. All pregnant women should have a documented VTE risk assessment at the booking appointment whilst the comprehensive history is being taken. This guideline written by Mid and South Essex Hospitals is designed to help maternity staff to identify, counsel and put the women who need antenatal and postpartum thromboprophylaxis on the correct pathway of care.- Posted
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Risk assessment for venous thromboembolism (2010)
Claire Cox posted an article in NICE
All patients should be risk assessed for venous thromboembolism (VTE) on admission to hospital. Patients should be reassessed within 24 hours of admission and whenever the clinical situation changes. This template checklist produced by the Department of Health and the National Institute for Heath and Clinical Excellence, is to aid the assessment in risk assessing patients for VTE.- Posted
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The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. NICE guidance, advice, quality standards and information services for health, public health and social care. Guidance also contains resources to help maximise use of evidence and guidance. This guideline (NG89) covers assessing and reducing the risk of venous thromboembolism (VTE or blood clots) and deep vein thrombosis (DVT) in people aged 16 and over in hospital. It aims to help healthcare professionals identify people most at risk and describes interventions that can be used to reduce the risk of VTE.- Posted
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VTE prevention: How can pharmacists contribute? (August 2011)
Claire Cox posted an article in Community pharmacies
Venous thromboembolism (VTE) is responsible for over 25,000 deaths a year in the UK, including 10% of hospital inpatient deaths. A House of Commons report in 2005 led to the development of guidance by the National Patient Safety Agency (NPSA), the National Institute for Health and Clinical Excellence (NICE) and the Chief Medical Officer, for the safe use of anticoagulants and other measures to prevent VTE (deep vein thrombosis and pulmonary embolism). VTE prevention is a patient safety priority for the National Health Service (NHS). The NICE 2010 guidance (CG92) requires that all adult hospital inpatients undergo a VTE risk assessment (RA) using a standardised national VTE RA template – upon admission, again 48 hours later, and whenever the patient’s clinical condition changes. Based on the national template, clinicians at Colchester Hospital University NHS Foundation Trust (CHUFT) pioneered an electronic VTE RA tool that enables the assessment to be completed in 30 seconds. This tool has the added benefits of calculating the risk of VTE and recommending appropriate prophylaxis using a pharmacological and/or mechanical agent. This decision support tool is web-based and is now available to any organisation across the globe. The tool and the VTE prevention programme at Colchester Hospital won the 2010 NHS Innovation Award for Patient Safety.- Posted
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Thrombosis UK is a charity and a leader in: Identifying, Informing & Partnering the NHS, healthcare providers and individuals to work to improve prevention of venous thromboembolism (VTE) and the management and care of unavoidable VTE events. This short video explains how a blood clot might form, what the risks are and how they might be treated.- Posted
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CareFlow Vitals is a mobile app and secure data storage system used to quickly and easily record patient’s vital statistics. This data is then instantly accessible to all relevant doctors, nurses or other specialists. Clinical staff can easily monitor patients, record observations and assessments, as well as escalate concerns. CareFlow Vitals has supported Barnsley Hospitals NHS Foundation Trust in delivering quality improvement and a patient safety culture. This short video explains how CareFlow has made improvements in recording venous thromboembolism assessments and in recording sepsis screening assessments.- Posted
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This cohort study in JAMA Network Open aimed to determine the prognostic performance of the simplified Geneva score and other validated risk assessment models (RAMs) to predict venous thromboembolism (VTE) in medical inpatients. The study provided a head-to-head comparison of validated RAMs among 1352 medical inpatients. It found that sensitivity of RAMs to predict 90-day VTE ranged from 39.3% to 82.1% and specificity of RAMs ranged from 34.3% to 70.4%. The authors concluded that the clinical usefulness of existing RAMs is questionable, highlighting the need for more accurate VTE prediction strategies.- Posted
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In this blog, Jo Jerrome, CEO of Thrombosis UK, explains the dangers of deep vein thrombosis (DVT) and why it is important for patients and staff to be aware of the risk factors. Jo offers advice on how we can all manage our risk of DVT, and introduces their award-winning, free patient app – “Let’s talk clots”. Are you at risk? Deep Vein Thrombosis (DVT) is a blood clot which has formed in the deep veins, usually in the legs. Often preventable, a DVT needs to be diagnosed and treated to avoid risk of a piece of the clot breaking off and travelling in the blood stream to the lungs where it can cause a life-threatening blockage known as a pulmonary embolism (PE). Risk factors for a DVT include: recent hospitalisation (especially for illness, surgery or trauma) cancer some cancer treatments prolonged immobility combined oral contraceptive pill hormone therapy when taken in tablet form pregnancy and up to six weeks postpartum a family history of thrombosis obesity smoking. Managing your risk of DVT Being aware of risk factors is really important in helping you to avoid and protect yourself from DVT. If you are aware you may be at risk of a blood clot, discuss this with your doctor or nurse. Keeping active, well hydrated and of healthy weight can also help reduce your personal risk of thrombosis. If there are medical risk factors – such as an active cancer or severe injury or trauma, then a doctor or nurse will assess your risk and may prescribe an anticoagulant to reduce the risk of a clot forming. Suspected or diagnosed DVT If you think you have signs or symptoms of a DVT or PE, it is vital to seek urgent medical advice for clinical investigations and diagnosis. If a blood clot is suspected or diagnosed, an anticoagulant medication is normally prescribed, usually in tablet form and this will need to be taken for at least three months, often longer depending on a clinical review and guidance. An anticoagulant – sometimes called a ‘blood thinner’ slows the body’s ability to form clots, hence reducing the risk of the clot becoming larger or more clots forming. This then reduces your risk while your body breaks down and dissolves the existing clot or clots. “Let’s talk clots” - free patient app Thrombosis UK has developed a medically approved information app – ‘Let’s Talk Clots’ which offers invaluable information on DVT and PE, including: symptoms information about risk factors diagnosis treatments help during recovery and restoring well-being after a diagnosis of a blood clot. Recovering after a blood clot? The app has information about recovery, including pain and breathlessness, managing anxiety and worry, regaining wellbeing, fitness and returning to everyday activities. Questions about life after a diagnosis of a blood clot? Information is shared about considerations around life events, including pregnancy, family planning, travel, work and managing other conditions or treatments alongside risk factors or a personal medical history of thrombosis. You can visit the Thrombosis UK website for more information about the app and how to download it.- Posted
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This article looks at how Sheba Medical Center in Tel Aviv, one of the largest health systems in the region, has used artificial intelligence to turn around statistics on patient safety. In 2016, the Accelerate Redesign Collaborate Innovation Center at Sheba launched a an AI solution called Aidoc to read CT scans. It is being used to more accurately predict stroke and pulmonary embolism, allowing healthcare professionals to offer preventative treatment more quickly that when CT scans are read purely manually.- Posted
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This report from Simon Milburn, Area Coroner for the area of Cambridgeshire and Peterborough, looks at the death of Jonathan Kingsman, who died of pulmonary thromboembolism and deep vein thrombosis on 1 February 2021. Mr Kingsman had been admitted to Fulbourn Hospital, Cambridge under section 2 of the Mental Health Act 1983 on 26 January. It was noted that on admission, Mr Kingsman had not consumed any fluids for several hours. The doctor on call carried out an initial risk assessment for venous thromboembolism (VTE), but as Mr Kingsman's mobility was deemed to 'not have significantly reduced ability', the assessor was directed by the guidance to stop the assessment. It was agreed at the Inquest that Mr Kingsman fell into this category and likewise agreed that throughout his time in hospital that there were no changes to his mobility which would have prompted a renewed risk assessment. However, Mr Kingsman did have other risk factors for VTE, and the coroner raised matters of concern about the risk assessment process as follows: That the risk assessment requires no consideration of risk factors other than mobility unless ‘Step 1’ is passed regardless of the number of other risk factors which may be present and their severity – Mr Kingsman was not obviously at risk of ‘significantly increased immobility compared to his normal state’ but died as a result of a DVT/VTE nonetheless. It is reasonable to expect that others may be in the same position in the future. The risk assessment form contains no guidance on its completion and no definition of certain terms. A copy of the report was sent to The Secretary of State for the Department of Health.- Posted
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This Swedish study in The BMJ aimed to quantify the risk of deep vein thrombosis, pulmonary embolism and bleeding after Covid-19. The authors found that incidence rate ratios were significantly increased 70 days after covid-19 for deep vein thrombosis, 110 days for pulmonary embolism and 60 days for bleeding, when compared to the control period. The study demonstrates that Covid-19 is a risk factor for deep vein thrombosis, pulmonary embolism and bleeding. Its results could impact recommendations on diagnostic and prophylactic strategies against venous thromboembolism after Covid-19.- Posted
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People with developmental disability have higher healthcare needs and lower life expectancy compared with the general population. Poor quality of care resulting from interpersonal and systemic discrimination may further entrench existing inequalities. Rocco Friebel and Laia Maynou examined the prevalence of five avoidable in-hospital patient safety incidents (adverse drug reactions, hospital-acquired infections, pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis, and postoperative sepsis) for four developmental disability groups (people with intellectual disability, chromosomal abnormalities, pervasive developmental disorders, and congenital malformation syndrome) in the NHS during the period April 2017–March 2019. The authors found that the likelihood of experiencing harm in disability groups was up to 2.7-fold higher than in patients without developmental disability. Patient safety incidents led to an excess length-of-stay in hospital of 3.6–15.4 days and an increased mortality risk of 1.4–15.0 percent. The authors show persisting quality differences in patients with developmental disability, requiring an explicit national policy focus on the needs of such patients to reduce inequalities, reach parity of care, and lower the burden on health system resources.- Posted
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This mixed methods study in the BMJ Open aimed to investigate possible barriers and facilitators for venous thromboembolism (VTE) risk assessment in medical patients and evaluate the impact of local and national initiatives. The authors identified the following barriers to risk assessment: involvement of multiple staff in individual admissions interruptions lack of policy awareness time pressure complexity of tools They concluded that national financial sanctions appear effective in implementing guidance, where other local measures have failed.- Posted
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