Everyone needed to know about blood clots

At Southern Cross Hospitals, we are always mindful of blood clots because we know they can cause serious illness or disability and that hospitalised patients are at a ten-fold increased risk of blood clots*. But not everyone knows the facts about blood clots. For example, did you know you are more at risk of developing a blood clot after a surgical procedure than you are from taking a long distance flight?

We know that the national incidence of people dying from blood clots in their lungs following elective surgery is 4.4 deaths per 100,000 procedures.
Source: Perioperative Morality Review Committee 2014, (2007 - 2011).

We also know it is impossible to prevent all blood clots, but that there are lots of ways to significantly reduce the risk – if you know what to do.

For those who would like to see the internal working:

"How blood clots form" and "A blood clot in your lungs" (Video source: WebMD).

*NZVTEP. (2012). National Policy Framework: VTE Prevention in Adult Hospitalised Patients in NZ. Wellington:HQSC.

New Zealand Herald article 

This 2012 article from the New Zealand Herald suggested most New Zealanders do not know what to do because they were ‘oblivious to blood clot dangers’; something we find very concerning. 

Read the full article.

What can we do to increase our patients’ awareness

Back in 2012, awareness of the seriousness of blood clots was growing both in New Zealand and overseas. While we believed our hospitals were already providing safe services, we felt that for such a serious risk we needed to look at how we could do even better. We made a start by reviewing our own processes as well as having another look at what was happening in relation to blood clot prevention both in New Zealand and internationally.

We recognised that the best efforts of doctors, nurses and pharmacists can’t deliver the safest outcomes alone. Why? Because patients need to play a pivotal role in blood clots prevention. We were surprised that patients were not more actively involved in managing their own risks and care. Our research revealed an opportunity to work together with our patients to raise their awareness of the risk and to provide the educative information they felt would be helpful.

Curious to know your risk? Curious to know your risk?  

*Southern Cross Hospitals Research Study. An exploration of patients’ engagement with and response to blood clot (venousthromboembolism; VTE) information and risk self-assessment tool provided to patients prior to surgery. Northern Y Ethics Committee approval NTY/12/01/004 (currently unpublished). 

So, we set about creating our blood clot information tool

This is our story.
It was right on Christmas time in 2012 when we asked some of our most recent patients for their help. It was a big ask during such a busy time, but on the evening of 23 December 2012 those patients and their partners were there to help us. This issue was important to them too.

What we learned was that reducing the risk of blood clots needed to be a dynamic process. Individuals wanted the option of accessing different levels of information – one size wouldn’t fit all – and we needed to look at the big picture and include care before and after a patient’s hospital visit. Patients told us they wanted to learn more about their individual risk profile and, in practical ways, what they could do to manage their own risks.

As a group, we prototyped how this might be delivered and together we designed a tool for patients and their families at every stage.

Download your copy of the brochure Download brochure  

Watch our Blood clots and YOU video

Have our efforts made a difference?

Do our patients feel more informed about blood clots risks?
Yes, each year we ask our patients about their overall impression of the service we provide, what they think we are doing well and what we could do better. A survey is undertaken by an independent Australian researcher. Following the introduction of our Blood clots and YOU tool in December 2013, we ask our patients if they receive adequate information about how to prevent or detect blood clots.

The results are impressive:

Reducing blood clots

Jan 2012

Expanded guidelines strengthened nursing's role and responsibilities in blood clots risk assessment, prevention and initial management within Southern Cross Hospitals

Jan 2014

Blood clots & YOU brochure introduced to patients what they could do to reduce their risk

Dec 2014

Blood clots investigation worksheet implemented to ensure appropriate assessment, prevention and management was undertaken during patient's hospital stay

Blood clots patients survey results

We ask our patients "have they received adequate information about how to prevent or detect blood clots?"

Apr 2014
0%
Apr 2015
0%
Apr 2016
0%
Apr 2017
0%

How has our care for patients improved?

As part of our fresh approach we reviewed the processes our nurses use to assess and manage the risk of blood clots and aligned these with the new tool. We developed an investigation worksheet so that every blood clot event is reviewed to check that the care provided meets our expectations based on the current best practice.

If we find something that can be improved we learn from it. One of the unique things about Southern Cross Hospitals is we have a network of 10 wholly owned hospitals, this means we can share best practice and lessons learned.

Sharing

We take patient safety very seriously and to us this is not a trade secret, we want to share what we’ve learned together and the tools we have developed so that all patients can benefit. So far, our ‘Blood clots and YOU’ tool is endorsed by Health Quality Safety Commission (HQSC), and is being used by all Southern Cross Hospitals, a number of District Health Boards and other private surgical hospitals. And we are happy to share with anyone else, just ask.

Sharing
Acknowledgements Acknowledgements  

Future measurement

We are further refining our approach to blood clot reporting in 2017 by adding this to our suite of clinical indicators*. This measure will include all blood clots where they are known.

We are currently introducing an electronic patient management system to all of our hospitals, called the Clinical Work Station (CWS). The CWS enables blood clot risk assessment and protection to be recorded electronically.

This will allow us to collect data to report on the following safety targets:

  • patients are blood clots risk assessed on admission 
  • patients will receive blood clots protection appropriate to their level of risk and bleeding considerations

*Southern Cross Hospitals established a comprehensive set of clinical indicators in 2007. These were reviewed in 2010 and again in May 2017. The review confirmed the indicators appeared to remain technically robust, interpretable, and informative (for clinical governance committees and benchmarking), reflected current accepted good practice and could assist in monitoring our care delivery processes to improve patient care.

Disclaimer: The figures shown for both New Zealand and for Southern Cross Hospitals reflect only those cases where a blood clot was identified as the main or attributed cause of death and where the patient was an elective admission for a hospital procedure involving an anaesthetic. The information provided in our results is limited to what we know and the data sources available to us.