Managing Cancer Associated Thrombosis: an electronic pathway to improved care

Summary

Building on the Integrated Care Pathway (ICP) for patients with cancer associated thrombosis (CAT) published in 2013, this initiative transferred the pathway’s treatment milestones from its proposed paper format into the electronic patient record. The use of the electronic patient record to facilitate the care pathway has made data collection a significantly more efficient process. The forms, once completed, also become instantly available for review by all users of the electronic patient record within the hospital and can be emailed to the patients’ GP as both a record of clinic attendance and as an active plan of care. Re-defining the CAT pathway into a series of electronic milestones has improved the quality of patient follow-up. 

Challenge

Cancer is estimated to be responsible for a fifth of all cases of incidentally diagnosed VTE with most cancer-associated VTE episodes occurring within 6 months of diagnosis. Cancer associated thrombosis (CAT) care requires the input of specialists with expertise in the area of anticoagulation management to ensure patients have a suitable treatment plan and receive appropriate follow-up to promote optimal concordance with anticoagulant therapy. The current standard treatment for CAT is Low Molecular Weight Heparin (LMWH) given sub-cutaneously for 6 months based upon patient weight with an indication for dose reduction after 30 days. The team found many areas where variations in care arose in the patient journey, particularly with regard to data collection, and where standardisation of the care approach was required. Review of the patient’s anticoagulation at six months failed to occur in almost all cases of CAT with little evidence of on-going plans for treatment being considered.

Objectives

To develop a systematic treatment pathway for patients with CAT within the electronic patient record currently utilised at Royal Cornwall Hospitals Trust. The aim was to improve and standardise the care for patients with CAT by achieving the following key objectives:

  • Improve rates of patient follow-up at 30 days to ensure the recommended reduction in treatment dose of LMWH at this point is actioned
  • Standardise data collection at each clinical review point
  • Improve efficiency and free nursing time by eliminating the need for separate paper documentation regarding clinical attendance/clinical treatment plans
  • Ensure a comprehensive follow up of patients at 6 months through the introduction of joint thrombosis/oncology clinic appointments
  • Increase staff awareness of patients diagnosed with cancer associated VTE

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QiC Anticoagulation Winner 2015
Management of thrombosis in cancer
Managing Cancer Associated Thrombosis: an electronic pathway to improved care
by Royal Cornwall Hospitals NHS Trust

Contacts

Andrew McSorley

Job title:
Lead Anticoagulation / Thrombosis CNS
Place of work:
Royal Cornwall Hospitals Trust, DVT Clinic, Treliske Hospital, Truro TR1 3LJ
Telephone:
01872 253827
Email:
Andrew.McSorley@rcht.cornwall.nhs.uk