Reducing mortality by preventing deep vein thrombosis (DVT)

DVT is a common cause of death in immobile hospital patients, but is potentially avoidable. Stroke patients in particular have a high risk of developing DVT due to restricted mobility. Good evidence from the CLOTS3 trial[1]  suggests that Intermittent Pneumatic Compression (IPC) is effective in preventing DVT and consequently reducing mortality in patients who are initially immobile after being hospitalised with acute stroke.

The CLOTS3 implementation project was a uniform adoption of IPC treatment across the South West for approximately 50% of in-patients with stroke for whom the treatment was applicable, in all acute settings. Existing network data indicated that the progress with the implementation of CLOTS3 was patchy across the South West, with some centres having fully implemented IPC, some with alternative devices or suppliers to the Covidien system used in the trial, and others at various stages of developing or approving business cases for procurement of the Covidien or other systems.

The project objectives were as follows:

  1. To work with centres to assess the demand for IPC equipment, and support procurement plans through the NHS IQ concession and into permanent local business plans;
  2. To develop and deliver to all sites a training intervention for junior medical staff, and registered and unregistered nurses in the identification of appropriate patients and the correct use of IPC;
  3. To support centres in collecting monitoring data through existing SSNAP mechanisms to measure the extent of implementation;
  4. To liaise with local Clinical Commissioning Groups regarding the use of CQUINs or other quality incentive schemes as levers for implementation for both NHS and non-NHS providers;
  5. To support and share good practice across the region;
  6. To build sustainability by incorporating the training intervention permanently into stroke unit teaching and training programmes;
  7. To liaise with local VTE prevention teams and with NHS IQ on the monitoring and progress of the project.

Moving forward training and education resources will be provided to maintain the safe applications of the IPC systems.

[1] Does intermittent pneumatic compression reduce the risk of post stroke deep vein thrombosis? The CLOTS 3 trial: study protocol for a randomized controlled trial Trials 2012, 13:26 doi:10.1186/1745-6215-13-26; http://www.medscape.com/viewarticle/805174.