In response to several examples of sub-optimal patient care, safety and patient experience in the management of venous thromboembolism in cancer patients, the team developed a dedicated cancer-associated thrombosis service.
The service, which comprises a multi-professional team, was developed through collaborative working across three clinical organisations and serves patients from seven district general hospitals. Key achievements so far include the development of consistent and safe practice in the management of cancer-associated thrombosis and the creation of formal shared care agreements between secondary and primary care for the safe prescribing of low molecular weight heparin.
Clinical incidents and poor patient experiences suggested that improvements were needed in how cancer associated thrombosis CAT was managed in South East Wales. A six month-long audit of CAT cases identified three areas of concern: the reluctance of primary care to prescribe LMWH; hospital admissions and increased bed stays arising from sub-optimal CAT management; and inconsistent practice across oncology in the management of CAT.
The inconsistent practice referred to a number of problem areas, including choice of drug, length of anticoagulaton and the monitoring of platelet count.
Two qualitative studies identified several issues which suggested the patient experience of CAT management was sub-optimal. Problems included insufficent support at diagnosis and unclear referral pathways.
The overall objective of the project were to develop a state-of-the-art cancer CAT service. Specific objectives were to improve local LMWH access for patients with CAT, to provide them with better access to information and support, and to ensure consistent referral pathways and practice in the management of CAT. The project also aimed to enable patients to participate in relevant clinical trials, and to develop an integrated service with relevant clincal stakeholders.
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