Please, please read –it’s long, but very important.I t might save some lives.

[HPNC]

I am a regular poster, but have changed my name. If you recognise me please don?t out me. My employers would not be happy that I have posted this.

A couple of weeks ago it was National Thrombosis Week.

Every year, in England, 25,000 ? twenty five thousand ? people die as a result of thrombosis.

That is more than the total deaths from HIV AIDS, breast cancer and road traffic accidents.

It is 25 times the number of deaths from MRSA.

Those 25,000 are the tip of a massive iceberg. They represent a fraction of the total number of people who suffer a thrombosis (blood clot, often called DVT or PE ?Pulmonary Embolism), often as a consequence of being admitted to hospital for medical or surgical treatment.

The single most effective patient safety intervention would be to assess a person?s risk of developing thrombosis when they are admitted to hospital, and to provide that person with the correct, appropriate treatment to prevent thrombosis occurring. (For example, correctly fitted stockings, plus or minus injections to reduce the risk of clotting).

The risk factors are well recognised and risk assessment is a straightforward process.

NICE have already established and implemented guidelines for prevention of thrombosis (thromboprophylaxis) in surgical patients.

NICE are currently drafting the guidelines for risk assessment and preventative treatment for all patients who are admitted to hospital. They will be implemented in 2009.

In April 2007 the Chief Medical Officer, Sir Liam Donaldson, wrote to the Chief Executive of every NHS Trust in England and Ireland stating that every Trust should establish a Thrombosis committee, and set up a system to risk assess every patient who is admitted to hospital, and that this should be mandatory.

By April 2008 only one third of NHS Trusts had taken any action. People are still suffering this horrible condition and still dying.

Please, if you possibly can, write to your local NHS Trust Chief Executive and ask what their Trust is doing to prevent patients dying unnecessarily from blood clots. Copy the letter to your MP.

If you, or a relative, are admitted to hospital for any reason, don?t just ask your doctor or nurse to wash their hands, ask them ?What is my risk of developing a blood clot, and what are you going to do to reduce my risk??

If you are pregnant, please ask your doctor and midwife the same question.

Thrombosis is still a leading cause of pregnancy-related death. If you are pregnant and are admitted to hospital for any reason (apart from straightforward labour and delivery) you should be risk assessed on admission.

We know what the power of mumsnet did for Waitrose baby bottom butter. I really hope we can achieve something here.

Thank you for reading, if you have managed to get this far.

not just pregnancy, im talking about general pateints...both med ical and surgical.

it is given due to the agreeing consensus as you say, but it is an interesting debate re nurses registration bieng at risk for continuing this practice.
in my jaded opinion, its only a matter of time before some one has a catasrophic bleed and the nurse is hung drwn and of course quatred for giving an unicense product...

bloods are not always checked prior to administration ofthe drug for a million reasons..not a defence tho is it?

One of the reasons for the 7 days, is because patients often go home within that time, and it is very expensive to get nurses to visit to administer injections.

It is becoming increasingly more acceptable to teach patients to self administer, so patients in more recent and current trials can carry on for longer, so the trial results will be based on longer periods of treatment. Licenses are based on trial results.

It is known that the risk period following surgery is actually longer than 7 days, so in practice, patients tend to continue until they are discharged.

btw i am not arguing with you about this, i am very interseted in what you say and agree with your sentiments. its just nice to have a debate and chat with some one in the business as it were hope you dont mind.

in patients, say ICU patients......

deanychip - Another very good reason why Trusts must set up thrombosis committees and produce policies and guidelines within which staff will work, so that everyone is protected.

If patients are properly assessed and staff are trained, the risk to the patient should be as low as it can be.

Risk can never be eliminated completely. But I think it is reasonable to treat a thrombosis than not to treat, and also to give the much lower, prophylactic dose to patients who are at high risk of developing a clot.

does your trust have all of these in place and in what form does the risk assessment take?
for eg, is it a flow chart type or questionarrie type, is it tons of yet more paperwork or is it short and simple?

ICU patients. I would absolutely expect a very ill patient to be under constant review, have regular clotting screens and for there to be consultation between specialists.

Risk assessment shouldn't just happen once, on admission, it should be part of the overall management.

The most obvious nursong intervention/observation would be for any sign of bleeding, however minor.

I am sure this happens in ICU anyway.

hm, would be good to integrate regular risk assessments in with the Waterlow assessment, done on a daily basis. not much additional paperwork, just an extra tick box to tick realy.

what would you put in it? you know, how would you word it?

but whose responsibility should it ultimately be to risk assess a patient...why should it fall onto the nurse again??

No, my Trust doesn't. And I am not happy about that.

It really shouldn't involve a lot of paperwork. Once doctors and nurses have awareness and training, it should be relatively easy to assess a patient's risk, and consider what level of thromboprophylaxis is appropriate.

It is up to the thrombosis committee to sort out what the policy should be, and design a simple, workable system. If one third of Trusts can do it, then so should the other 2 thirds.

The current level of mortality and morbidity is just not acceptable.

i get what you are saying however it tends to be just the norm for all admissions (unless coaguopathic)to automatically be put on low molecular weight heparin and ted stockings are put on them..
in my trust the prescription is pre printed with heparin and with gut protection drugs and so jsut needs signing.

are you saying that this is not enough?

I had a PE about 6 months after breast cancer surgery and just after finishing chemotherapy - nobody said specifically that it was caused by either of those, but I was definitely told that it was a common consequence, and nobody had mentioned it beforehand.

I have already designed a risk assessment tool. But i won't go into it too much as I am trying to remain anonymous.

No, I personally don't think the risk assessment should be the nurses responsibility.

Prescribing thromboprophylaxis is a medical intervention, and therefore, I think it should be part of the medical clerking process.

The waterlow assessment is related to nursing intervention.

But I would hope that all staff would be aware of, and familiar with the agreed policy and protocol (put together by the thrombosis committee!)

There are different systems in place in different trusts, and I think we can all learn from each other and eventually come up with the best of the best IYSWIM.

deany chip, your trust sounds great that it has a system in place. My point is that 2 out of 3 Trusts don't have anything like that. Patients just don't get any thromboprophylaxis, or they get innappropriate or inadequate thromboprophylaxis. And end up with clots.

i know and agree...totaly unnaceptable.

ok, am off to bed, thanks for the chat. We have kept it current in the convos.

Wendyweber - sorry to hear about your PE.

Are you still having treatment? It is worth dicussing your future management with your doctor.

I hope you are recovering. It must have been an awful experience.

deanychip - I am pleased we have reached agreement

Thanks, HPNC - it was 7 years ago though so I am well clear now.

It was scary - the inability to take more than the shallowest breaths without excruciating pain was shocking, but luckily my GP was at the Health Centre 5 minutes away and came straight round and gave me a wonderful injection of diamorphine ("Harold Shipman's drug of choice" he told me cheerily )

I had heparin injections for a few weeks, and also had daily blood clotting tests (this was mixed in with daily radiotherapy for a while too, it was a crap summer for the kids); then took warfarin for 6 months and was finally signed off and have had no recurrence - I use red wine as a regular prophylactic

Do you know if it would have been a consequence of the surgery (7 months before) or the chemo? Or neither?

Being unlucky enough to have cancer is a risk factor for developing thrombosis, Wendy.

I wouldn't like to speculate about the definite cause. But under the current/proposed NICE guideline, a patient in your situation should definitely be risk assessed and the oncologist and the haematologist should agree on what thromboprophylaxis would be appropriate.

I am glad to hear you have recovered.

I was lucky, wasn't I, really?

It would be good to know that there is an awareness of this risk now, and that preventive (preventative?) measures would be taken automatically...apart from the life-saving potential it must actually be cheaper in the long run?

WW my mum had a thrombosis during chemo too - was told it was a combination of cancer and sitting in a hospital bed for 4 weeks with chemo indiced pneumonia.

I still think she's lucky though - survived it all!

Ah, that's a good point, Kewc - I didn't have the 4 weeks in bed like your mum, but I was v v sedentary for 6 months during the chemo. Maybe the chemo regime should include a daily exercise session.

like chemo olympics - 100 yds dash whilst holding on to the chemo drip?

I know this is slightly different but my dad was diagnosed with a spontanious DVT a week and a half ago, hospital sent him home 3 days on the trot before this because his only symptom was an acheing calf finally they scanned him and said he does have a DVT - he has had to give himself heperin injections everyday since 21st May and had to start taking warfarin last weekend as well - he went back to hospital to have his blood checked this week and it is still at the same level Does this mean the drugs aren't working and is he still at risk of the DVT breaking off?? They have now said he has to carry on with the injections and have doubled his warfarin dosage. He is not old (59), not overweight, not sedentary(sp?), hasn't travelled recently, suffered no trauma to his leg and has not had a operation for 8 years .... does this mean he has some form of cancer somewhere that is causing it? Sorry, I know you are not here for diagnosis but it is worrying me. Thanks

Just a quick reply mummy2T&F

He will stay on the injections until his warfarin dose is right, and he will be monitored throughout his treatment to make sure he is on the right dose. It is normal to take a little while to get the warfarin level right. Then he will stop the injections and just carry on with the tablets.

He will be investigated for all possible causes. It doesn't necessarily mean he has anything sinister wrong with him. He is getting the right treatment.

HTH. I know you are bound to worry, but hopefully they will get to the bottom of it.

I am glad he has been diagnosed and treated.

I am on my way to bed now.

Thank you to all who have read, and contributed to, this thread.

I really hope it hasn't scared anyone too much.

I hope the information has been helpful and empowering to people. Don't be afraid to ask what your hospital is doing to tackle this problem. If more people draw attention to it, things have to improve.