BC Cancer Agency Patient VTE Prophylaxis Team

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Patients who are diagnosed with cancer are a vulnerable population and have six times the risk of a blood clot developing inside a blood vessel (Venous Thromboembolism (VTE)) annually when compared to the general population. This risk increases after any cancer treatment procedures are applied because of tissue injury and immobility during recovery.

Approximately 70% of blood clots that occur inside blood vessels occur while patients are at a hospital. VTE events are the most preventable cause of death in the hospital setting. In BC, the number of patients with hospital-acquired VTE is estimated to be 3,000 annually – with up to one third of patients developing long-term complications such as post-thrombotic syndrome (lingering pain, swelling, redness or ulcers and limited mobility), or chronic high blood pressure. The burden of hospital-acquired VTE on health care resources is substantial.

At the BC Cancer Agency, only 15% of patients were receiving VTE prophylaxis (VTEP) to reduce the risk of VTE-related complications, but evidence suggests at least 90% of cancer patients could benefit from the practice. An interdisciplinary and cross agency team, including patients, collaborated and used innovative process redesign to attempt to increase the number of eligible patients receiving VTEP from 15% to 100%.

The team set out to achieve this by simplifying the patient admission process.The VTEP assessment and an intervention checklist were incorporated into a new, user-friendly pre-printed admission order checklist. Oncology physicians would often have to write many of their admission orders by hand; but the team optimized compliance through the use of a form that made the overall admission process easier, faster and safer for patients.

The team also decided to use a blood thinner that was more convenient and did not require patients to receive as many injections as the previous anticoagulant. All of these steps made the process easier for physicians, while at the same time reducing the workload for nursing and unit clerk staff.

The team achieved its goal of 100% of eligible patients receiving VTEP in early Fall 2011 – well ahead of the project’s target date. Ongoing audits reveal that the gains have been sustained throughout 2012. The team also reports that patients are now better informed and have a voice in asking for and receiving VTEP as appropriate for their health and safety.