Nursing Practice Innovation Venous thromboembolism


Keywords: Venous thromboembolism/ Risk assessment/Appreciative enquiry/


Engagement ●This article has been double-blind peer reviewed


A hospital thrombosis team brought about a trustwide change in thromboembolism prevention by focusing on successes and using a collaborative approach with staff


Collaborative working to reduce VTE


In this article... How to involve staff to bring about a change in practice Motivating staff through positive feedback How to improve VTE prevention


Authors Emma Gee is a coagulation nurse specialist; Lynda Bonner is a consultant nurse in thrombosis and anticoagulation; both at King’s College Hospital Foundation Trust, London. Abstract Gee E, Bonner L (2012) Collaborative working to reduce VTE. Nursing Times; 108: 36, 24-26. The thrombosis team at King’s College Hospital used innovative methods to bring about a change in the trust’s VTE prevention practice. The team took a structured approach with a focus on positive aspects of practice. The aim was to involve clinical staff by forming partnerships rather than using a dictatorial approach. The creation of a nurse and midwife link network and valuing the individuality of clinical areas were fundamental to successful change.


2010b) published guidance and quality standards and the Commissioning for Quality and Innovation (CQUIN) payment framework linked healthcare providers’ income to the implementation of VTE risk assessment. Trusts were given a structure in which to achieve the highest standards of VTE prevention and a way of illustrating this to patients and commissioners. The thrombosis team at King’s College


I


Hospital felt the best way to change VTE practice throughout the trust would be to devise a strategy that involved staff and encouraged a collaboration. The team, set up in 1999, comprises three doctors, one consultant nurse, six specialist nurses, four research fellows, two pharmacists and an administrator.


n 2010, the prevention of venous throm- boembolism (VTE) came into the spot- light when the National Institute for Health and Clinical Excellence (2010a;


Getting staff involved A five-step involvement continuum was used to encourage staff to become involved with VTE prevention; this had been designed to develop public involvement in healthcare and we adapted it for use with clinical staff (Department of Health, 2003). Its five steps progress from minimum to maximum involvement (Box 1). Alongside the involvement continuum,


we used “appreciative enquiry” – a method of organisational development that focuses on affirmation and being positive. In healthcare, there is a culture of learning from clinical incidents and undertaking analysis when things go wrong. Apprecia- tive enquiry enhances learning by looking at what went right, celebrating these achievements and disseminating the information to improve practice. It has been described by nurses as a fresh approach in a context that tends to focus on the negative (Kavanagh et al, 2010).


Giving information The aim of the information-giving phase was to raise awareness and educate staff about VTE prevention and what the NICE guidance meant for them and their patients. First, we identified who needed to be


reached and which methods would suit different groups. The VTE thrombosis team delivered a large amount of in-house training and created an electronic VTE learning module, which we made available to all clinical staff. Throughout this phase we worked to


increase awareness in the trust through display stands at hospital events and a VTE awareness event that coincided with junior doctors starting at the trust. We used local media to reach staff by promoting our


24 Nursing Times 04.09.12 / Vol 108 No 36 / www.nursingtimes.net


Time and resources were invested in staff discussions


5 key points


1


A systematic trustwide


approach to preventing venous thromboembolism is crucial for patient safety and to reduce costs


2 3


When planning change


involving other people, it is important to be flexible


Staff involvement


and development should be tailored to the needs of the individuals, teams and areas involved


4


spent on gathering and disseminating information is invaluable for building


5 partnerships


Staff often appreciate the


opportunity to highlight, celebrate and learn from successes


Time and resources


Alamy


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40