The Thrombosis Committee: an Instrument for

Governance & Change

Dr Roopen AryaKing’s College Hospital, London

Health Committee recommendations 2005

• Thrombosis committee should be established in each hospital, with a specialist thrombosis team.

• Modelled on existing Blood Transfusion teams and committees.

• A basic standard of expectation should be issued by the DOH pending publication of NICE guidelines.

Health Committee recommendations 2005

• Thrombosis Committee: all interested parties including haematologists, surgeons, physicians, anaesthetists, obstetricians, nursing staff and pharmacists.

• Ensure clinical governance and provide a local audit of thromboprophylactic procedures in each hospital.

Health Committee recommendations 2005A potential draft remit of the Thrombosis Committee:• Promote best practice through local protocols based on

national guidelines.• Lead multi-professional audit of the use of thromboprophylaxis

focusing on specialties where risk is high.• Promote education and training of all clinical and support staff.• Have the authority to modify existing VTE and risk

assessment protocols and to introduce appropriate changes to practice.

• Consult with local patient representative groups where appropriate.

• Contribute to the development of clinical governance.

Health Committee recommendations 2005

Thrombosis Teams would:• Assist in implementation of Thrombosis

Committee’s objectives.• Promote and provide advice and support re:

appropriate thromboprophylaxis and risk assessment.

• Actively promote implementation of good thromboprophylaxis practice.

• Be a source for training all hospital staff involved in dealing with patients at risk of VTE.

King’s’ experience

• Anticoagulation/thrombosis committee

• Established 1999,quarterly meetings

• Multidisciplinary group: physicians, surgeons, imaging drs and technicians, nurse specialists, pharmacists

• Instrument for clinical governance and driving change

Background• Adverse incidents related to anticoagulation• Awareness of mortality & morbidity due to

VTE at King’s• ‘Ad hoc’ management of clinical thrombosis• Practice variations and lack of clear

guidelines • Manage change - new anticoagulants and

treatment strategies

• Identify stakeholders within Trust• Multidisciplinary core group + invite

relevant parties• Terms of reference• Resource implications• Decide on agenda: be focused

Setting up a thrombosis committee:

Agenda items• DVT and PE care pathways• New anticoagulant drugs• Choice of LMWH• Thrombolysis for PE• Thromboprophylaxis for surgical patients• Thromboprophylaxis for medical patients• Anticoagulation prescription charts• Audit of anticoagulation & thromboprophylaxis• Adverse incidents relating to anticoagulation

Achievements• Establishment of clinical thrombosis services• Policies for thromboprophylaxis and treatment

of VTE• Policies regarding anticoagulation• Trustwide consensus & clinical guidelines• Promote clinical research • Resource for education and training• Vital part of the Trust framework for clinical

governance & audit

Integrated Care Pathway for DVTIntegrated Care Pathway for DVT

KCH guidelines for medical thromboprophylaxisKCH guidelines for medical thromboprophylaxis