The four professions* (doctors, nurses, midwives and pharmacists) have come together to review the evidence for prevention of hospital-acquired venous thromboembolism (VTE), and to advise their members to follow NICE recommendations on risk assessment and prevention for VTE.
The current NICE guidance provides the most clinically- and cost-effective measures for VTE prophylaxis in patients at risk of VTE in hospitals, and compliance with this best practice for VTE makes financial sense for the NHS, which is under pressure to reduce costs.
The statement is a response to calls for consideration of VTE prophylaxis for medical patients and finds that there is significant support for the prevention methods currently in use ‒ risk assessment of patients for VTE and administering of preventative treatment for those found at risk of VTE.
House of Commons Health Select Committee figures estimate that 25,000 avoidable deaths occur every year in the UK from hospital-acquired VTE. Recent Hospital Episodes Statistics data for 2010‒2011 found that over 56,000 people ‒ around 1,000 per week ‒ were diagnosed with blood clots in their legs or lungs.
Spokespeople quotes
RCP president Sir Richard Thompson welcomed the guidelines:
At present, the great majority of, but not all, patients at risk are screened for VTE. We must be vigilant in ensuring that all patients are screened. Screening should be a routine part of practice, and robust systems put into a place at every hospital so that patients at risk of VTE do not slip through the net.
Jane Munro, quality and audit development advisor, Royal College of Midwives said:
Venous thromboembolism is 10 times more common in pregnant than in non-pregnant women of a similar age and is a leading direct cause of maternal mortality in the UK. We have known for some time that there should be wider use of prophylaxis and better recognition and investigation of classic symptoms, we are therefore very pleased to be collaborating on raising awareness of the importance of risk assessment and the effective preventative treatment available.
Professor Terence Stephenson, chair of the Academy of Medical Royal Colleges said:
VTE remains a huge issue and is a major cause of death of in hospitals. It is vital that all clinical staff are following the most up-to-date and effective clinical practice to tackle VTE. That is why we have reviewed that advice previously produced on behalf of the professional bodies representing the professions of medicine, nursing, midwifery and pharmacy. The Academy continues to support its members and other professional bodies in recommending and bringing to the attention of their members and fellows the best possible ways to deal with VTE. In light of recent studies we remain certain that the NICE guidelines are the most appropriate to follow.
Sharron Millen, pharmacist and spokesperson for VTE for the Royal Pharmaceutical Society said:
Pharmacists have a key role in supporting the VTE agenda as part of a multidisciplinary team. One of the key skills a pharmacist holds is an ability to assess complex evidence and make a pragmatic judgment on the balance of the evidence presented. This skill remains fundamental within the VTE agenda based on the publication of the LIFENOX trial. The evidence to support the use of appropriate thromboprophylaxis in at-risk patients has not changed. Pharmacists need to continue to ensure that routine risk assessment is embedded in clinical practice and appropriate prescribing follows.
Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing said:
Any avoidable death is an individual tragedy and a failing for the health service as a whole. Venous thromboembolisms, or blood clots, can affect anybody, but this guidance shows that we do have the knowledge and skills to identify those at risk and work to prevent them. The challenge now is to prevent them every time. Nurses have innovated and tackled this challenge head-on in recent years, and will welcome the opportunity to work with other professions to ensure that the best practice happens everywhere. By working together, the professions should be able to drastically reduce or even eradicate this distressing, preventable condition.
Key points
- 93.4% of the 3.3 million adult patients admitted to NHS-funded acute care between April and June 2012 were assessed for risk of VTE. This is an increase from the previous quarter, when 92.5% of patients were assessed, and it is the second quarter that the target of 90% of patients being assessed for VTE has been met.
- The total number of patients assessed since the programme began in July 2010 is around 21 million. Currently over 260,000 patients are being assessed every week.
- This approach to VTE is unique ‒ the NHS in England is the first healthcare system in the world to assess patients in this way.
For further information, please contact Hannah Bristow, Clinical Standards communications officer, on +44 (0)20 3075 1447 / 07584 303 784 or email Hannah.Bristow@rcplondon.ac.uk
- The NICE guidance referred to is CG92.
- Action to prevent VTE happens regularly on wards but does not, at present, cover every single patient who is at risk. This statement is to raise awareness of VTE with the professions, reminding them of its importance and to ensure that all patients at risk are screened.
- VTE refers to blood clots that occur inside veins. The majority of deaths from VTE are caused when part of the clot breaks off, and eventually blocks the pulmonary arteries in the lungs (pulmonary embolism)
- Patients who survive pulmonary embolism often develop comorbidities, including post-thrombotic syndrome (swelling of the legs) which can impact on quality of life.
- *The four professions are: Royal College of Physicians, Academy of Medical Royal Colleges, Royal College of Midwives, Royal College of Nursing and Royal Pharmaceutical Society.