Tara on the team to improve standards

 

A career interest in cancer care led Tara Redemski to represent her profession in developing the national ‘Venous Thromboembolism Clinical Care Standard’ to prevent patients acquiring the condition process in hospital and following discharge.

The standard is designed to not only minimise venous thromboembolism (VTE) in an at-risk population but also provide positive impact in the delivery of services at a clinical level for physiotherapists.

‘People with cancer, or undergoing cancer treatment, are at much higher risk of developing VTE than the healthy population, so it’s something that I see fairly regularly,’ says Tara, a senior physiotherapist at Gold Coast University Hospital. ‘It is a significant health problem but there are a large number of patients who do not receive prophylaxis as per international guidelines. The document provides guidance on what is the recommended standard of care in preventing VTE within clinical practice, so we can use it to advocate for patients.’

VTE is a potentially preventable disease and includes deep vein thrombosis (DVT) and pulmonary embolism and, according to the Australian Commission on Safety and Quality in Health Care, is a major cause of morbidity and mortality for patients admitted to hospital—and a common preventable cause of in-hospital death. It is estimated to account for 10 per cent of all deaths in Australian hospitals, and the consequence of developing VTE has been estimated to cost the national health system $1.72 billion annually.

Previous clinical guidelines were rescinded in 2016 as national and international data signalled at-risk patients were failing to receive care as recommended ‘despite the availability of international evidence- based best-practice guidelines’, the commission states on its website. The commission proposed that a revised standard could improve the uptake of appropriate VTE prophylaxis strategies.

Selected key health professionals, including emergency clinicians, surgeons and pharmacists, would form the working group (TWG), tasked with reviewing the updated clinical care recommendations. Consumers were also represented. Tara was chosen through a recommendation from the national chair of the APA Cardiorespiratory Group, Penny Schofield, APAM, who knew of Tara’s extensive clinical expertise and experience in delivering VTE education workshops. The group had an intensive 12 months to review material.

‘It was an honour to be selected and represent the APA,’ Tara says. ‘The TWG was on a much bigger scale than the state-wide working groups I had previously been involved with and had a broader range of people from different health backgrounds. As it was designed solely to develop the clinical care standard it was valuable to have a physiotherapist within what was largely a medically focused working group, as I could provide a different viewpoint.’

Representation of the profession also came with its challenges, as the review of each element within the standard emphasised a need for medical evidence based on detailed study.

‘When discussing appropriate prevention, it was difficult to balance advocating hard for physiotherapy, knowing that the evidence to support it is still largely relying on expert opinion. In treating DVTs we have evidence in Level II from randomised controlled trials, but in terms of prevention there is little to none because you cannot ethically do a study. For physiotherapists, it is a juggling act in this area—we know mobility can reduce DVT but we don’t have the evidence to back us up, so our expert opinion cannot compare with medical evidence that is based on an actual study. I relied on support from the APA to manage this in discussions.’

To ensure a holistic approach in prevention, resources have been produced for health services, clinicians, patients and their carers. Indicator specifications are also available to monitor implementation of the standard within health services.

‘I particularly like that the clinical care standard addresses the three groups of users, so everyone will know what to expect in terms of delivering and receiving healthcare. The standard is important to all physiotherapists because it covers the prevention of VTE in adults from presentation to hospital at admission through to discharge to the community. At any stage in this journey, patients may see a physiotherapist, which means we should understand the risks of VTE and know how to use the standard to support the delivery of high-quality care,’ Tara says.

Visit safetyandquality.gov.au to access resources.

Tara Redemski, APAM, works in cancer care as part of a multidisciplinary oncology team. She is a graduate of Griffith University. Her clinical interests include women’s health and the physiotherapy management of VTE.
 

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