At Salisbury District Hospital, Salisbury NHS Foundation Trust provides a range of clinical care, which includes general acute and emergency services to approximately 200,000 people in Wiltshire, Dorset and Hampshire. Specialist burns, plastic surgery, cleft lip and palate, genetics and rehabilitation services extend to more than three million people, with the spinal treatment centre covering most of southern England, with a population of around 11 million people.

Like many other hospitals in the UK we had no systematic approach to VTE risk assessment of all inpatients until early 2008 at which time only half of eligible patients were receiving thromboprophylaxis.  We embarked upon a process aimed at ensuring that all patients admitted to the Trust would receive appropriate individualised measures to minimise their risk of VTE.

We developed a simple means of documenting VTE risk with a 'risk box' on the front of the drug chart (low, high or very high [previous VTE]) together with a recommendation for prophylaxis (usually Dalteparin 5000iu daily) and space to document any contraindications to prophylaxis or reassessment of risk.

Risk decisions and treatment are facilitated by a simple algorithm.  All patients additionally receive mechanical compression in the operating theatre.

In May 2009 we started to use Rivaroxaban as extended prophylaxis following total hip & knee replacements instead of extended Dalteparin prophylaxis.

From 2008, the Trust carried out a trust-wide quarterly audit of VTE measures. Information from these audits was used as part of an intensive education programme and to keep staff and patients continually informed of progress in VTE prevention on a ward-by-ward basis.  By July 2009 the number of patients receiving VTE prophylaxis had risen to 92%.

There has been a significant fall in the number of VTE that result from hospital admission and in more serious VTE events, such as pulmonary emboli.  Any VTE event is reviewed by the thrombosis committee and information is fed back to the relevant clinical teams so that they have a better understanding of their own performance based on clinical outcomes.

The Trust was awarded Exemplar status in December 2009 and continues to work hard within the organisation and with other hospitals to share its knowledge and experience and achieve the best thromboprophylaxis for all patients.

If you would like more information on any aspect of our policy, our implementation programme or would like to visit us, please contact Dr Tamara Everington, Chair of the Thrombosis Committee via tamara.everington@salisbury.nhs.uk