This specialist Guidelines summary covers the NICE quality standard for the management of venous thromboembolism in adults. This summary has been produced for use by cardiology teams. For information on rationales and quality measures, refer to the full quality standard from NICE.
List of Quality Statements
Quality Statement 1: Timing of Pharmacological Venous Thromboembolism Prophylaxis
- People aged 16 and over who are in hospital and assessed as needing pharmacological venous thromboembolism (VTE) prophylaxis start it as soon as possible and within 14 hours of hospital admission.
Quality Statement 2: Venous Thromboembolism Risk Assessment for People With Lower Limb Immobilisation
- People aged 16 and over who are discharged with lower limb immobilisation are assessed to identify their risk of VTE.
Healthcare professionals (such as doctors, allied health professionals, trauma teams and orthopaedic specialists) carry out a risk assessment for people aged 16 and over who are discharged with lower limb immobilisation to identify their risk of VTE and decide whether they need pharmacological VTE prophylaxis. They discuss the outcome of the assessment with the person and involve them in making decisions about pharmacological VTE prophylaxis if it is needed. They also give verbal and written information to people and their family members or carers about the signs and symptoms of VTE, how to reduce their risk of VTE and how to seek help if VTE is suspected, as well as the benefits and possible side effects of pharmacological VTE prophylaxis.
Quality Statement 3: Proximal Leg Vein Ultrasound Scan for a 'Likely' Deep Vein Thrombosis Wells Score
- People aged 18 and over with a deep vein thrombosis (DVT) Wells score of 2 points or more have a proximal leg vein ultrasound scan within 4 hours of it being requested.
Quality Statement 4: Venous Thromboembolism Anticoagulation Review
- People aged 18 and over taking anticoagulation treatment after a venous thromboembolism (VTE) have a review at 3 months and then at least once a year if they continue to take it long term.
Healthcare professionals (such as GPs, specialists and nurses) carry out a review for people aged 18 and over taking anticoagulation treatment after a VTE after 3 months of treatment to discuss the benefits and risks of continuing, stopping or changing the anticoagulant. They give people information about when their anticoagulation will next be reviewed. They also carry out a review for people taking long-term anticoagulation treatment for secondary prevention of VTE at least once a year to review general health, risk of VTE recurrence, bleeding risk, adherence, side effects and treatment preferences. They make sure that they review and update the information, advice and support given to people when they started having anticoagulation treatment.
Quality Statement 5: Follow-up for Outpatients With Low-risk Pulmonary Embolism
- People aged 18 and over having outpatient treatment for suspected or confirmed low-risk pulmonary embolism (PE) have an agreed plan for monitoring and follow-up.
Healthcare professionals (such as specialists, specialist nurses and allied health professionals) discuss and agree a plan for monitoring and follow-up with people having outpatient treatment for suspected or confirmed low-risk PE. They provide them with written information on symptoms and signs to look out for, direct contact details of a healthcare professional or team with expertise in thrombosis to discuss concerns with, and information about out-of-hours services they can contact when their secondary care healthcare team is not available. They should provide adequate information to enable people to make an informed decision about outpatient management.