Clinical Features

End of Year Review: Thrombosis Ireland

What is the leading cause of PREVENTABLE disability and death in your hospital? Blood Clots

Written by Ann Marie O’Neill, Patient Founder, Thrombosis Ireland

Venous thromboembolism (VTE) compromising deep vein thrombosis (DVT) and Pulmonary embolism (PE) is the leading cause of death and disability worldwide. In Ireland, VTE remains the leading cause of maternal mortality. Globally, two thirds of all cases of VTE are hospital acquired, meaning that they occur either during a patient’s hospital stay or within 90 days of discharge. In majority of patients, such events are preventable through timeous risk assessment, initiation of appropriate prophylaxis and patient education. In many cases, VTE is treatable, but if undetected, can be potentially fatal.

Blood Clots do not discriminate. One collaborative study by the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) study found that at least 1 in 12 middle-aged adults will develop venous thromboembolism in their remaining lifetime. They can happen to anyone. Male or female, young or old. Blood clots are more likely to occur in a person with two or more risk factors at any given point in time.

You may be at higher risk of a blood clot if:
• You are admitted to hospital and for 90 days after you go home.
• You have active cancer or are receiving cancer treatment.
• You are pregnant or have had a baby less than 6 weeks ago.
• You have recently been immobile for a prolonged period (more than 3 days in bed/ travel non-stop for 6 hours/ lower limb injury or in a leg cast)

Your risk my increase further if:
• You or a close relative had a previous blood clot.
• You have had surgery in the last 90 days.
• You have thrombophilia (blood clotting condition)
• You are taking the combined oral contraceptive pill or HRT.
• You have heart lung or inflammatory disease • You are over 60 years of age or are overweight.
• You have varicose veins that become red and sore.

Thrombosis Ireland was established in 2016 to address the lack of awareness and education programs for both patients and health care professionals regarding VTE and the complexities of its prevention and management. Through education campaigns and hospital drives, we aim to increase VTE risk awareness amongst health care providers and users, empowering clinicians, and patients to spot the signs early. In addition, we are strong advocates for the establishment of a coordinated rehabilitation program to support VTE patients during their recovery period and hope to work alongside hospitals in the future to develop such initiatives.

Our first initiative was to produce a wallet-sized, laminated Blood Clot Alert, card which would provide all the necessary information to a patient with respects to VTE risk factors, early warning signs to watch for and the importance of seeking medical attention if they suspect a blood clot. In 2017, Thrombosis Ireland participated in the HSE VTE Collaborative, an initiative led by Ms Ciara Kirke and the HSE Medication Safety Improvement Program.

From this collaborative effort in 2018, a number of HSE VTE Safety recommendations were developed. Preventing Blood Clots in Hospitals ( This report summarises the learning from the collaboration and provides a toolkit to facilitate hospitals with further improvement, including patient alert cards which have been provided to all hospitals.

Hospitals Must Ensure that:
• Oversight for monitoring and improving VTE prevention is assigned to the appropriate governance committee and is an agenda item at meetings at least twice a year.
• An adequately resourced multidisciplinary team is supported to carry out quality improvement to reduce hospital acquired VTE. Preventing Blood Clots in Hospitals 3 • A VTE prevention protocol is in place, accessible and staff are aware of it.
• The protocol is followed for each in-patient as soon as possible after the decision to admit is made, and correct prophylaxis received asap and within 24 hours.
• Tools and processes which have been found to be effective are in place, e.g. independent check(s) of prophylaxis, education for staff and patients and prompts/alerts, e.g. pre-printed prescriptions.
• Each in-patient receives information about any VTE prophylaxis they are receiving, their risk of VTE for 90 days after hospitalisation, the signs and symptoms of VTE and what to do if they occur, facilitated by providing the Patient Alert Card.
• Responsibilities are assigned for, following the VTE prevention protocol and prescribing prophylaxis, independently checking prophylaxis and ensuring patients receive information prior to discharge.
• Monitoring of key metrics takes place at least quarterly and is reviewed at the appropriate governance committee. This includes a new national key performance indicator, together with measuring the percentage of patients with appropriate prophylaxis and monitoring whether patients are receiving alert cards.
• Hospital-acquired VTE is reported and managed in accordance with the HSE Incident Management Framework, including open disclosure.
• Hospital-acquired VTE is listed as a risk on the hospital’s risk register.

As a patient led organisation, we have worked hard to encourage and drive the implementation of these recommendations to ensure that patient’s receives the best possible standardised care. It has been truly uplifting to witness various hospitals implement safety initiatives to improve VTE awareness, prevention and management throughout their hospitals and communities at large. This year for World Thrombosis Day 2022 we provided VTE awareness event kits for 35 of our acute hospitals, our National Ambulance Service and Lifeline Ambulance service along with Blood Clot Alert Cards for hundreds of Community Pharmacies. We also ran a VTE coffee cup awareness campaign and distributed 100,000 recyclable/compostable cups through many community coffee outlets, hospital coffee shops and canteens and UCD and NUIG while running a national radio advertising campaign on Newstalk and Today FM.

The movement of change has been growing year on year and we have a mechanism for monitoring, acknowledging and thanking all those who are helping us to make a difference through our ‘ Thrombosis Ireland VTE Exemplar Awards’.

Our 2022 winners are as follows:- Best Hospital Group:

Ireland East Hospital Group Best Hospital: Cork University Hospital, Cork.

Best Maternity Hospital: Rotunda Hospital, Dublin

VTE Scientific Advancement: The Mater Misericordiae University Hospital

VTE Quality Improvement: Tallaght University Hospital, Dublin

VTE Quality Improvement Maternity Hospital: Our Lady of Lourdes Maternity Hospital, Co. Louth

VTE Warrior Awards: Katherine Quinn, Anticoagulation Nurse Specialist, Tallaght Hospital, Dublin. Therese O’Brien, Anticoagulaton Nurse Manager, Portiuncula University Hospital, Galway Dr. Su Maung, Haematologist, Our Lady’s Hospital, Navan, Co. Meath Lidhy Solomon,

VTE Clinical Nurse Manager, Mater Misericordiae University Hospital, Dublin Prof. Fionnuala Ni Ainle, Consultant Haematologist, Mater Misericordiae University Hospital, Dublin

Our 2022 VTE Champion’s Award went to: Mullingar Regional Hospital for their Patient Safety Initiative – DOAC Dosing Quick Guide.

We were responsible for lighting up many national monument and public buildings throughout the country on October 13th to highlight World Thrombosis Day and link with all of our other VTE Awareness initiatives. Looking to the future, what we require is a strong national direction for the prevention and management of VTE in Ireland. We are so much closer to having this. In October this year, the HSE appointed Prof. Fionnuala Ni Ainle as the HSE National VTE Lead with Miriam Kennedy as the National Program Manager. We are hopeful that the passion and momentum of this team will shine a new light for VTE in Ireland. In the meantime, I would appeal to each hospital group and individual hospital, to ensure that all HSE VTE Collaborative recommendations are imbedded into daily practice in your organisation, and in particular, the VTE Risk Assessment for every person who presents at your hospital, not just those admitted and direct your blood clot patients to Thrombosis Ireland education and support services through our website

Together we are so much stronger. #Spot the Signs #Save a life

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