Venous Thromboembolism Prevention Clinical Care Standard

The Venous Thromboembolism Prevention Clinical Care Standard has been developed by the Commission to support clinicians and health services implement the delivery of high-quality care to prevent venous thromboembolism (VTE) acquired in hospital and following hospital discharge.

Introduction

Venous thromboembolism (VTE) is a major cause of morbidity and mortality for patients admitted to hospital, and a common preventable cause of in-hospital death. It is estimated to account for 7% of all deaths in Australian hospitals, and the consequence of developing VTE has been estimated to cost the Australian health system $1.72 billion annually.¹

Despite the availability of international evidence-based best-practice guidelines for the prevention of VTE, data from Australia and internationally^2-4 suggests that a significant proportion of patients at risk of VTE do not receive care as recommended in current guidelines.

Guide for implementing the VTE Prevention Clinical Care Standard

The Commission has developed a guide to support the implementation of the Venous Thromboembolism Prevention Clinical Care Standard. The Implementation Guide: Venous Thromboembolism Prevention Clinical Care Standard provides a range of strategies, recommendations and case studies, as a starting point for clinicians and health service organisations implementing the clinical care standard.

Thumbnail for VTE CCS Implementation Guide

Venous Thromboembolism Prevention Clinical Care Standard: Implementation Guide

2020

Guide, user guide or guidelines

What is venous thromboembolism (VTE)?

Venous thromboembolism (VTE) is a disease process that includes deep vein thrombosis (DVT) and pulmonary embolism (PE).

Deep vein thrombosis (DVT)	Occurs when blood clots form in veins, usually deep inside the legs or in the pelvis, where they may cause symptoms like pain, tenderness, redness, or swelling of the leg.
Pulmonary embolism (PE)	Occurs when a blood clot breaks off and moves through the veins to block blood vessels in the lungs. This may cause symptoms like shortness of breath, coughing up blood, chest pain, faintness, and loss of consciousness. If the clot blocks enough blood vessels in the lungs, the person can die.⁵

Download the Standard

This resource provides guidance to consumers, clinicians and health services on the care recommended to prevent VTE in hospital and following hospital discharge.

The Venous Thromboembolism Prevention Clinical Care Standard has been endorsed by 12 key professional organisations and colleges including the Thrombosis & Haemostasis Society of Australia and New Zealand (THANZ), the Royal Australasian College of Surgeons (RACS), the Australian Orthopaedic Association (AOA), and the Australian College for Emergency Medicine (ACEM).

Venous Thromboembolism Prevention Clinical Care Standard (2020)

2020

Publication, report or update

Implementing clinical care standards helps health service organisations to meet the requirements of the National Safety and Quality Health Service (NSQHS) Standards for accreditation.

Quality statements

Quality Statement 1 - Assess and document VTE risk

A patient potentially at risk of VTE (as determined by local hospital/unit policy) receives a timely assessment of VTE risk using a locally endorsed evidence-based tool to determine their need for VTE prevention. The result is documented at the time of the assessment, in a place that is easily accessible to all clinicians involved in the patient’s care.

Purpose

To ensure that patients potentially at risk of VTE receive a timely assessment and documentation of that risk, so that all clinicians involved in the patient’s care have access to the results and are aware of the patient’s VTE prevention needs.

Quality Statement 2 - Develop a VTE prevention plan, balancing the risk of VTE against bleeding

A patient assessed to be at risk of VTE has a prevention plan developed that balances the risk of thrombosis against the risk and consequences of bleeding (as an adverse effect of VTE prevention medicines). Other contraindications to VTE prevention methods are also considered before offering any to the patient.

Purpose

To ensure bleeding risk and other possible contraindications to VTE prevention are considered prior to the development of a patient’s VTE prevention plan.

Quality Statement 3 - Inform and partner with patients

Quality Statement 4 - Document and communicate the VTE prevention plan

Quality Statement 5 - Use appropriate VTE prevention methods

Quality Statement 6 - Reassess risk and monitor the patient for VTE-related complications

During hospitalisation, a patient’s thrombosis and bleeding risk is reassessed and documented at intervals no longer than every seven days, whenever the patient’s clinical condition or goals of care change, and on discharge from hospital. The patient is also monitored for VTE-related complications each time risk is reassessed.

Purpose

To ensure that the VTE prevention plan is adapted to respond to changes in a patient’s thrombosis and bleeding risk while they are in hospital, and that there is early recognition of VTE-related complications such as bleeding, thrombosis, or erroneous concomitant prescribing of medicines used to prevent VTE.

Quality Statement 7 - Transition from hospital and ongoing care

A patient at risk of VTE following hospitalisation receives a written discharge plan or care plan before they leave hospital, which describes their ongoing, individualised care to prevent VTE following discharge. The plan is discussed with the patient before they leave hospital to ensure they understand the recommended care and follow-up that may be required. The plan is also communicated to the patient’s general practitioner or ongoing clinical provider within 48 hours of discharge so that ongoing care to prevent VTE can be completed in accordance with the plan.

Purpose

To minimise the likelihood of adverse events following transitions of care by ensuring a patient at risk of VTE and their general practitioner or ongoing clinical provider receive a discharge plan or care plan that describes the ongoing care the patient requires to prevent VTE after they leave hospital.

Implementation resources

Use these resources to implement and promote the Venous Thromboembolism Prevention Clinical Care Standard to health services, clinicians, patients and their carers.

Thumbnail of VTE CCS Clinician Fact Sheet

Venous Thromboembolism Prevention Clinical Care Standard – Clinician Fact Sheet

2018

Fact sheet or brochure

Thumbnail for VTE CCS Consumer Fact Sheet

Venous Thromboembolism Clinical Care Standard - Consumer fact sheet

2018

Fact sheet or brochure

Venous Thromboembolism Prevention Clinical Care Standard - Poster

2018

Poster or graphic

Indicator specifications

This resource provides a set of suggested indicators to assist with local implementation of the Venous Thromboembolism Prevention Clinical Care Standard. Clinicians and health services can use the indicators to monitor implementation of the quality statements, and support improvements as needed.

The indicator specification is available from METeOR.

Background information

Despite current efforts, evidence suggests that a large proportion of hospitalised patients are at risk of VTE, however many patients do not receive appropriate VTE prophylaxis.^6,7VTE prevention strategies have been shown to significantly reduce the incidence of VTE by about 70%.

While the incidence of VTE among hospitalised patients is 100 times greater than in the community⁸, the risk of developing VTE also continues after discharge from hospital. Hospitalisation is a major risk factor for VTE, with about 74% of VTE cases occurring up to three months after hospital discharge.⁹

The key clinical guideline in Australia for VTE prevention in hospitalised patients was rescinded in 2016.⁵The development of the Venous Thromboembolism Prevention Clinical Care Standard was proposed by states and territory health departments as a way of improving the uptake of appropriate VTE prophylaxis strategies.

Venous Thromboembolism Prevention Clinical Care Standard - Evidence Sources

2018

Publication, report or update

Thumbnail for Burden of VTE in Aust report, VTE CCS.

The burden of venous thromboembolism in Australia

2008

Publication, report or update

If you have any questions about the Venous Thromboembolism Prevention Clinical Care Standard, please email ccs@safetyandquality.gov.au

References

Access Economics Pty Ltd for the Australia and New Zealand working party on the management and prevention of venous thromboembolism. The burden of venous thromboembolism in Australia, 1 May 2008. Access Economics Pty Ltd; 2008.
Cohen AT, Tapson VF, Bergmann J-F,Goldhaber SZ, Kakkar AK, Deslandes B, et al.Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387–94.
Kahn SR, Panju A, Geerts W, Pineo GF, Desjardins L, Turpie AG, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res. 2007;119(2):145–55.
Tapson VF, Decousus H, Pini M, Chong BH, Froehlich JB, Monreal M, et al. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest. 2007;132(3):936–45.
National Health and Medical Research Council. Clinical practice guidelines for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals (rescinded 2016). Melbourne: NHMRC; 2009.
Assareh H, Chen J, Ou L, Hillman K, Flabouris A. Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study. BMC Health Services Research. 2016;16:511.
Cohen A, Tapson V, Bergmann J-F, Goldhaber S et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. The Lancet. 2008; 371:387-394.
Heit JA, Melton LJ, III, Lohse CM, Petterson TM, Silverstein MD, Mohr DN, et al. Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clinic Proceedings. 2001.76(11):1102-10.
Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ. Venous thromboembolism in the outpatient setting. Archives of Internal Medicine. 2007;167(14):1471-5.

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