National VTE Audit Day Results

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National VTE Audit Day RESULTS

Bill Geerts & Artemis Diamantouros Virginia Flintoft, Anne MacLaurin and Alex Titeu

CPSI Central Measurement Team May 2013


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National VTE Audit Day RESULTS

Bill Geerts & Artemis Diamantouros Virginia Flintoft, Anne MacLaurin and Alex Titeu

CPSI Central Measurement Team May 2013


1. Methodology

2. Audit participation

3. Appropriate thromboprophylaxis use

4. Types of thromboprophylaxis used

5. Reasons for not using appropriate thromboprophylaxis

6. Use of Preprinted order sets

7. Feedback and discussion

VTE Audit Day Results - Outline

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• National VTE Audit Day: April 10, 2013

• Audit Sample: – General Internal Medicine and General Surgery

• National webinar (Mar 26) - Call to Action

• Engagement of sites & registration

• Each site contacted by CMT: – Identification of audit sample – Creation of data collection forms

VTE Audit Day - Overview

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• Launch of National VTE Audit: April 10, 2013

• Data Collection: April 10 to 18 – Extension for data submission to April 30

• Error reports corrected and resubmitted by Central Measurement Team (CMT)

• Analyses conducted by CMT with data from Patient Safety Metrics (PS Metrics)

VTE Audit Day - Methodology

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1. Methodology








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Overall Response Rate

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Sites 118 Patients 4,667


Responses by Province

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Site

s

118 sites 4,667 patients


Responses by Major Patient Group

12

64% N=4,628

31%

2%

Site

s

2%


1. Methodology








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Appropriate Thromboprophylaxis - Overall Rates

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81%

N=4,667 %

of p

atie

nts


Appropriate Thromboprophylaxis - By Major Patient Group

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79% 84%

% of

pat

ient

s


Appropriate Thromboprophylaxis - by Province

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100%

% of

pat

ient

s 65%


Appropriate Thromboprophylaxis - by Province and Major Patient Group

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% of

pat

ient

s


Appropriate Thromboprophylaxis - by Province and Region

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Regions Reporting

National Average = 81%


1. Methodology








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Type of Thromboprophylaxis - Overall

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• LMWH = dalteparin, enoxaparin, fondaparinux, nadroparin, tinzaparin • Other = apixaban, dabigatran, rivaroxaban, warfarin (only 6%)

N=4,581 (3,619 on TPX)

LMWH + LDH = 90% LMWH = 61%

(4%)


Type of Thromboprophylaxis – by Major Patient Group

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Patient group

Patients on TPX

LMWH LDH Mech Only

Gen Med 2225 69.5% 20.8% 4.6%

Gen Surg 1211 45.3% 45.6% 3.3%


Type of Thromboprophylaxis - by Province

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Type of Thromboprophylaxis - by Province and Major Patient Group

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Type of Thromboprophylaxis - by Province and Region

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1. Methodology








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Reasons for not using Thromboprophylaxis - Overall

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(72.2%)

(8.7%)

(8.1%)

(6.3%)

N=767


Reasons for not using Thromboprophylaxis - by Major Patient Group

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Reasons for not using Thromboprophylaxis - by Province

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Reasons for not using Thromboprophylaxis - by Province and Major Patient Group

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Reasons for not using Thromboprophylaxis - by Province and Region

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1. Methodology








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Preprinted Order Use - Overall Rates

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N=4,667

55%

% of

pat

ient

s


Preprinted Order Use – by Major Patient Group

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% of

pat

ient

s

57% 51%


Preprinted Order Use – by Province

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% of

pat

ient

s


Preprinted Orders – by Province and Major Patient Group

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% of

pat

ient

s


Preprinted Orders – by Province and Region

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% of

pat

ient

s

100%

3%


Receiving Appropriate Thromboprophylaxis and Preprinted Order Sets

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N=4,518

Order set used

Order set not used

91%

71%


• 1st Canadian national VTE thromboprophylaxis audit

• 118 centres and 4,667 patients

• Coast to coast representation

• Medical and surgical patients well represented

Summary - Participation

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• Overall, thromboprophylaxis use = 81% - Very good (but with room for improvement)

• Variability in thromboprophylaxis use: - By patient group:

– General surgery 84% – Medical 79%

- By province: 65% 100%

- By region within provinces

Summary – Thromboprophylaxis Use

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Summary – Types of Thromboprophylaxis

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• Types of Thromboprophylaxis: • LMWH: 61% • LMWH + LDH: 90% • Mechanical only: 4%

• Variability: • By Patient Group:

• Medical: LMWH vs. LDH (70% vs 21%)

• Surgical: LMWH and LDH similar (45% and 46%)

• By province • By region within provinces


• Overall: – 19% did not receive appropriate

thromboprophylaxis • Reasons:

• No thromboprophylaxis 70% • Delay in start 9% • Wrong dose 8% • Modality varied from SHN recommendation 6%

Summary – Reasons for not using Thromboprophylaxis

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• 55% of patients had admission / postop OS • Huge differences by province (13% 63%)

and region • Appropriate thromboprophylaxis was more

common if OS used (71% vs 90%)

Summary – Order set use

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• Some provinces not represented: – Quebec, NMT, Yukon, Nunavut

• Potential participation bias: – ?good centre bias – ?good nursing unit bias

• Snap shot Audit

Summary - Limitations

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1. Methodology








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• Less than 20% response rate • 2/3 rated the tool at very good –

excellent • 2/3 indicated that they would continue to

use the tool to collect VTE data • 100% indicated they would participate in

another audit day next year • We still want to hear from you!

Feedback Survey link: http://survey.patientsafetyinstitute.ca/n/zzzfm.aspx

VTE Audit Day Feedback Survey

http://survey.patientsafetyinstitute.ca/n/zzzfm.aspx


Thank you!

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• Questions • Comments/suggestions • How can Safer

Healthcare Now! help you?


Thank you!

Central Measurement Team [email protected]

Virginia Flintoft – 416-946-8350 Alexandru Titeu – 416-946-3103

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mailto:[email protected]

National VTE Audit Day Results

Health & Medicine

Transcript of National VTE Audit Day Results