Wilson Rachel
United Kingdom.
BMJ Qual Improv Rep. 2015 Aug 19;4(1). doi: 10.1136/bmjquality.u209203.w3760. eCollection 2015.
Cardiology wards are generally high turnover units, which may receive primary PCI, high-risk NSTEMI patients, and other general cardiac admissions from a large geographical area. Many centres also provide national specialist services for rarer cardiac conditions for which admissions may be lengthy. Cardiac patients have significant risk factors for venous thromboembolism (VTE) as immobility may be due to systolic dysfunction, attachment to continuous monitoring and predisposition to chest pain, or cardiac syncope. It is recommended by NICE that an initial VTE risk assessment is undertaken at the time of patient admission, with reassessment within 24 hours. For this purpose a risk assessment tool is featured on the front of many Trust drug charts. It is noted that this risk assessment is electronic in other trusts. We undertook an audit into the drug chart documentation of VTE risk assessment on the cardiology ward and the Coronary Care Unit (CCU) at The Royal Free Hospital. It was evident that documentation of VTE risk assessment was poor. The audit interventions were; a teaching presentation to the cardiology department, an educational poster, several update emails to the department and the identification of a 'VTE risk assessment champion' to audit ongoing compliance. Following these measures the second audit round demonstrated that documentation of initial risk assessment was slightly improved, but significant improvement was seen in documentation of risk assessment at 24 hours post admission. Results from a third audit cycle indicated that the improvement in initial VTE risk assessment was sustained, and that there was a significant sustained improvement in risk assessment at 24 hours (p <0.05). Recommendations for sustained improvement included: redesigning the drug chart so that the VTE risk assessment tool was linked to the VTE prophylaxis prescription box, and designating the responsibility of the initial VTE risk assessment to the on call junior doctor who receives admissions on to the ward.
心脏病房通常是周转率较高的科室，可能会接收来自广大地理区域的直接经皮冠状动脉介入治疗（primary PCI）、高危非ST段抬高型心肌梗死（NSTEMI）患者以及其他一般心脏科住院患者。许多中心还为一些罕见的心脏疾病提供全国性的专科服务，这些疾病的住院时间可能较长。心脏病患者有静脉血栓栓塞（VTE）的显著风险因素，因为他们可能因收缩功能障碍、连接持续监测设备以及易患胸痛或心脏性晕厥而活动受限。英国国家卫生与临床优化研究所（NICE）建议在患者入院时进行初始VTE风险评估，并在24小时内重新评估。为此，许多信托机构的药品图表正面都有一个风险评估工具。需要注意的是，在其他信托机构中，这种风险评估是电子化的。我们对皇家自由医院心脏病房和冠心病监护病房（CCU）的VTE风险评估药品图表记录进行了一次审核。很明显，VTE风险评估的记录情况很差。审核采取的干预措施包括：为心脏病科举办一次教学讲座、张贴一张教育海报、向该科室发送几封更新邮件以及确定一位“VTE风险评估负责人”来审核持续的合规情况。采取这些措施后，第二轮审核表明初始风险评估的记录略有改善，但入院后24小时的风险评估记录有了显著改善。第三次审核周期的结果表明，初始VTE风险评估的改善得以持续，并且入院后24小时的风险评估有了显著的持续改善（p<0.05）。持续改进的建议包括：重新设计药品图表，使VTE风险评估工具与VTE预防处方框相关联，并将初始VTE风险评估的责任指定给负责接收病房入院患者的值班初级医生。
