Abstract
BackgroundMost patients with pulmonary embolism (PE) spend 5–7 days in hospital even though only 4.5% will develop serious complications during this time. In particular, the group of patients with incidentally diagnosed PE (i-PE) includes many patients with low risk features potentially ideal for outpatient management; however the evidence for their optimal management is lacking hence relative practices may vary considerably. We describe the development process, components, links and function of a nurse-led service for the management of patients with i-PE, developed in accordance to the UK Medical Research Council complex intervention guidance.MethodsPhase 0 (Theoretical underpinning): The Pulmonary Embolism Severity Index (PESI) was selected for patient risk assessment and the American Society of Clinical Oncology (ASCO) guideline for the management of PE in cancer patients (2007) was selected as quality measure. Historical registry and audit data from our centre regarding i-PE incidence and management for the period between 2006 and 2009 illustrating the then current practices were reviewed. Phase 1 (Modelling): Modelling of the pathway included the following: a) Identification of training needs, planning and implementation of training schemes and development of transferable competencies and training materials. b) Mapping patient pathways and flow and c) Production of key documentation and Standard Operating Procedures for the delivery of the service.ResultsPhase 2 (Implementation and testing of the intervention): During the initial 12 months of implementation, remedial action was taken to address identified deficiencies regarding patient referral to the pathway, compliance with treatment protocol, patient follow up, selection challenges from the use of PESI in cancer patients and challenges regarding the “first-pass” identification of i-PE.ConclusionWe have developed and piloted a complex intervention to manage cancer patients with incidental PE in an outpatient setting. Adherence to evidence- based care, improvement of communication between professionals and patients, and improved quality of data is demonstrated.
Highlights
Many common clinical problems in medicine and general practice relate to arterial and venous thrombosis
Oncology patients were almost twice as likely to die of PE as those patients with benign disease and about 60% of those deaths occurred prematurely
Therapeutic treatments including chemotherapy and surgery further increase the risk for thrombosis
Summary
Many common clinical problems in medicine and general practice relate to arterial and venous thrombosis. Venous Thromboembolism (VTE) is a frequent problem in patients with cancer and represents a major clinical complication. There are few standardised protocols for the management of oncology patients who develop VTE and care can often be fragmented. An audit was undertaken July-October 2008 to assess the incidence and management of incidental VTE in cancer patients in Hull and East Yorkshire Hospitals NHS Trust. It was apparent from the audit that there was no single standard of care, or any documentation of assessment, treatment outcome and complications. The aim is to provide a high quality, flexible and equitable service to all oncology/ haematology patients within the Humber and Yorkshire Cancer Coast Network who require management of incidental VTE. Practitioner workbook can be found on pages 6 – 15 of the Practitioner Pack. Sign off sheet can be found on page 8 of the Supervisor pack
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call