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College president backs Academy Venous thromboembolism prevention plan

16 April 2010

The Academy of Medical Royal Colleges is today launching a five point plan to cut the number of deaths from Venous Thromboembolism (VTE) after research shows that many of the estimated 25,000 deaths a year could be prevented.

VTE is a condition in which a blood clot (thrombus) forms in a vein. Blood flow through the affected vein can be limited by the clot, and can cause swelling and pain. Venous thrombosis occurs most commonly in the deep veins of the leg or pelvis; this is known as a deep vein thrombosis (DVT). An embolism occurs if all or a part of the clot breaks off from the site where it forms and travels through the venous system. If the clot lodges in the lung a potentially serious and sometimes fatal condition, pulmonary embolism (PE) occurs.

Assessing the potential risk to patients and, where appropriate, implementing measures such as encouraging patients to wear compression stockings and routinely prescribing anticoagulant medicine can dramatically reduce the risk of VTE.

The initiative, which is being launched by the Medical Royal Colleges, in parallel to the work of the Department of Health and Strategic Health Authority Medical Directors, is aimed at making clinicians more aware of the potential for VTE and the steps that can be taken to reduce risk to patients
Professor Sir Neil Douglas, Chairman of the Academy of Medical Royal Colleges said, “VTE kills many patients a year and is a largely preventable if all patients admitted to hospital are assessed for VTE prevention and appropriate action taken.

The set of actions agreed by the Medical Royal Colleges is an excellent example of strong clinical leadership that can make a real difference to patients’ lives. Coupled with the clear actions taken by the Department of Health this provides a real opportunity for the health service to tackle this long standing issue. I believe this is a good model of clinical, managerial and government leadership working together for the benefit of patients.”
The work for the Academy was led by John Black, President of the Royal College of Surgeons of England who said; “It is proven that simple preventative measures could dramatically reduce death and damage to the leg due to post-surgical VTE. The guidance by NICE earlier this year that all hospitals should have a plan in place to screen for vulnerable patients and provide appropriate treatment now points hospitals the way and sets the standard. This plan from the Academy of Medical Royal Colleges gives these NHS Trusts the means to meet this obligation.”

All Colleges and Faculties have agreed to:

  1. Bring to the attention of all their Fellows and Members the importance of risk assessment and appropriate prophylaxis for venous thromboembolism in all patients admitted to hospital. This includes the assessment of risk in primary care at the time of referral to hospital.
  2. Emphasise that all Fellows and Members should ensure that their clinical unit has systems in place to ensure all patients are assessed for VTE prophylaxis and that the reasons for the resulting decision are documented and appropriate therapy given. This may be achieved through modifying drug charts, for example.
  3. Ensure Fellows and Members participate in regular audit of the percentage of patients risk-assessed for VTE. In some specialties this is suitable for becoming a mandatory standard for revalidation.
  4. Produce specialty-specific guidance where needed.
  5. Continue emphasis of the importance of VTE in undergraduate and postgraduate curricula and training programmes, and promotion through various e-learning initiatives.

Notes for editors

VTE has been made a top priority by Department of Health and is included in the 2010/11 NHS Operating Framework for England, where it was explicitly stated that that Academy and Colleges should provide professional leadership in this arena.
This is the first time that the joint delivery of a clinical objective has been agreed and included in the Operating Framework.
Other action taken as part of the VTE campaign includes:

A national risk assessment tool for use on admission to hospital has been agreed via Connecting for Health.

  • The NHS system levers to be used are:-
    Commissioning for Quality and Innovation (CQUIN) payment frameworkto receive CQUIN monies all organisations will be required to show that at least 90% of patients admitted undergo risk assessment using the national risk assessment tool.

    National contracting process –Acute hospitals will be required to report to their lead commissioner monthly audits of the percentage of patients risk-assessed for VTE who subsequently receive the appropriate prophylaxis.
    Providers must perform a root cause analysis of all episodes of confirmed hospital acquired pulmonary embolism (PE) and deep vein thrombosis (DVT).
  • NICE have produced updated guidelines on VTE prophylaxis (http://guidance.nice.org.uk/CG92 ) in conjunction with the Royal College of Physicians’ National Clinical Guidance Centre, and will be producing a related Quality Standard
  • The National Quality Board has established a sub-group chaired by Sir Bruce Keogh to explore how to spread best practice in the NHS with respect to VTE.

For more information and interviews contact:
Alistair Henderson, Chief Executive, AoMRC 0207 831 7171
Matt Worrall, Head of Media RCS Eng 0207 869 6047
Max Prangnell, AoMRC 0773 436 1055