References
Implementing Wells' criteria to improve deep vein thrombosis screening in housebound patients

Abstract
Background:
Screening of deep vein thrombosis (DVT) is an NHS priority for improving community health service. Effective DVT screening and documentation improve patient outcomes, prevent prolonged hospitalisation and lead to fewer expenses. The lack of evidence of DVT screening in the community requires action. This Quality Improvement Project focuses on improving DVT screening and documentation for housebound patients in the community.
Aim:
To improve screening and documentation of DVT in four months by introducing several interventions in collaboration with one care community.
Methods:
The authors used a fishbone analysis and driver diagram to form three ‘Plan, Do, Study and Act’ cycles. The authors also developed a Wells' template, delivered a training session, had a team meeting with community nurses, audited their screening records and collected their feedback.
Findings:
There was a 74% increase in staff using the National Institute for Health and Care Excellence guidelines and 100% documentation of DVT assessment, of which 82% used the Wells' score template.
Conclusions:
DVT screening and documentation in community services can be optimised and sustained with training and monitoring.
Community health services have flourished since the introduction of the NHS England (NHSE) Long Term Plan (2019), and patient's home is now considered the most economical place to provide patient-centred care (NHSE, 2021). As part of the plan, it is a requirement that a diverse, multidisciplinary team (MDT) delivers a network of integrated community services. Therefore, in community settings, services are tailored to patients' needs to prevent hospital admissions, enhance quality of life (QoL) and support earlier discharge from hospital.
NHSE assigned each Trust a 2-hour urgent crisis response service within this web of services (NHSE, 2021); advanced clinical practitioners (ACPs) and trainee advanced clinical practitioners (tACPs) provide advanced care and coordinate this initiative within community services, providing patients with advanced clinical skills at the point of crisis and delivering strategies based on evidence-based practice (NHSE, 2017).
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