Diagnosis and Treatment of Suspected Deep Vein Thrombosis

CLINICAL POLICY 

Diagnosis and Treatment of Patients with a Suspected Deep Vein 

Thrombosis Policy 

For use in: PCT-wide 

Target Audience: All Trust Clinical Staff 

Purpose Policy for the diagnosis and treatment of 

patients with a suspected Deep Vein 

Thrombosis 

Document Author: Jenny Murphy 

Approved by: Clinical Guidelines Group or Equivalent 

Ratified by: Policy Sub-Committee (PSC) 

Policy Indexed: HStHCL218 

Version Number: 2.0 

Effective From: February 2010 

Review Date: February 2013 

Statutory and legal requirements Policy based on recommendations from the 

NHS Litigation Authority 

Implementation Lead Jenny Murphy 

Implementation Process Refer to attached dissemination plan 

The Trust is committed to creating an environment that promotes equality and embraces 

diversity, both within our workforce and in service delivery. This document should be 

implemented with due regard to this commitment 

This document seeks to uphold the duties and principles contained within the Human Rights 

Act. All Staff within the PCT should be aware of its implications 

This policy is due for review by February 2013. After this date, this policy and associated 

process documents may become invalid. All users should ensure that they are consulting the 

current version of this document.

Key individuals involved in developing the document (Internal Staff Only) 

Name(s) 

Designation 

Jenny Murphy Advanced Practitioner 

Elaine McDowell Clinical Service Manager 

Distributed to the following for approvals and comments 

Committee(s) 

Members of the Policy Sub Committee (PSC) 

Members of the Clinical Policies Guidelines 

Group (CPG) 

Individual(s) 

Designation 

Chris Turner Head of Urgent Care 

Phillip Chalmers Divisional Manager 

Linda Spooner Professional Development Manager 

Page 2 of 40

Table of Contents 

Introduction ..................................................................................................................................4 

Purpose........................................................................................................................................4 

Scope...........................................................................................................................................5 

Policy ...........................................................................................................................................5 

Training Requirements.................................................................................................................7 

Duties and Responsibilities ..........................................................................................................7 

Document Storage and Filing.......................................................................................................8 

References...................................................................................................................................9 

Appendix 1 .................................................................................................................................10 

Appendix 2 .................................................................................................................................12 

Appendix 3 .................................................................................................................................14 

Appendix 4 .................................................................................................................................23 

Appendix 5 .................................................................................................................................24 

Appendix 6 .................................................................................................................................25 

Appendix 7 .................................................................................................................................26 

Appendix 8 .................................................................................................................................27 

Appendix 9 .................................................................................................................................28 

Appendix 10 ...............................................................................................................................29 

Appendix 11 ...............................................................................................................................30 

Appendix 12 ...............................................................................................................................31 

Appendix 13 ...............................................................................................................................32 

Appendix 14 ...............................................................................................................................33 

Appendix 15 ...............................................................................................................................35 

Appendix 16 ...............................................................................................................................37 

Appendix 17 ...............................................................................................................................38 

Appendix 18 ...............................................................................................................................39 

Appendix 19 ...............................................................................................................................40 


INTRODUCTION 

To comply with the requirements of the Clinical Negligence Scheme for Trusts, Risk Pooling 

Schemes for Trusts, best practice and NHS guidance, the Trust has implemented an effective 

community diagnostic and treatment service for the treatment of deep vein thrombosis in non - 

complex patients in a nurse led environment. 

An effective community diagnostic and treatment service promotes quality of life and reduces 

the necessity for attendance at the Emergency Department. This document describes the 

clinical pathway for patients who are referred by their GP or who self refer to the Widnes Walkin 

Centre or the St Helens Minor injuries / Walk-In Centre with a suspected DVT. 

Administration of Enoxaparin carries potential risks and should only be given if the benefits 

outweigh these risks. Stringent guidelines must be followed to ensure that the correct drug and 

dose is given to the correct patient at the correct time and that any adverse reactions are dealt 

with promptly and efficiently in accordance with hospital/PCT policies. 

This policy is supported by Nursing and Midwifery Council guidelines Standards for Medicines 

Management. 

PURPOSE 

The purpose of this policy is designed to provide comprehensive guidance to all qualified nurses 

within the Walk-In Centres who have undergone appropriate training in delivering a community 

DVT service and must be read in conjunction with the Enoxaparin PGD. This policy will enable 

the organisation to fulfil its obligations under the NHS plan. 

Objectives 

To sustain a stream line and non – fragmented deep vein thrombosis service across 

NHS Halton and St Helens Primary Care trust 

To offer the patient a safe and effective diagnostic and treatment service and promoting 

quality of life 

To reduce the necessity to attend Emergency Department and GP assessment unit 

therefore reducing hospital admission 

Outcome 

To reduce the patient journey 

Prevent unnecessary medical referrals 

Effective use of resources within the NHS 

More effective treatment of patients with suspected non – complex Deep Vein 

Thrombosis 


SCOPE 

This policy applies to all qualified nurses within the Walk-In Centre teams who have received 

training and met competencies both practically and theoretically. 

POLICY 

This policy acknowledges St Helens and Knowsley Acute NHS Trust in their support in assisting 

in the delivery of the community DVT Service. 

This process describes the clinical pathway for patients with suspected DVT either self 

referring or referred by their GP (see appendix 6) 

If the patient is deemed suitable for community diagnosis and treatment, the patient will 

then be commenced on the DVT pathway (Appendix 3). 

Following a holistic assessment, which will include the Wells score, the Nurse Practitioner 

will fully discuss the process with the patient. If the patient is happy to proceed with the 

pathway, verbal informed consent, to be treated at the WIC by a nurse practitioner, will be 

given and recorded. 

Bloods will be taken for D-dimer, LTF,s, U+E’s, FBC and where patient is a diabetic blood 

will also be taken for glucose levels. 

the result of the D Dimer and Wells score will determine if the patient commences the 

relevant DVT pathway and Enoxaparin via PGD ( appendix 4) administered 

This process describes the clinical pathway for patients with suspected DVT either self 

referring or referred by their GP when the near/ on site patient testing machine is out of 

order. 

If the patient is deemed suitable for community diagnosis and treatment, the patient will 

then be commenced on the DVT pathway (Appendix 7). 

Following a holistic assessment, which will include the Wells score, the Nurse Practitioner 

will fully discuss the process with the patient. If the patient is happy to proceed with the 

pathway, verbal informed consent, to be treated at the WIC by a nurse practitioner, will be 

given and recorded. 

Bloods will be taken for D-dimer, LFT’s, U+E’s, FBC and where patient is a diabetic blood 

will also be taken for glucose levels. 

Bloods will be transported either via normal collection ( twice a day) or taxi. Staff at 

Whiston Pathology lab haematology department will be contacted via telephone re 

request. 


Once a D Dimer result has been received this and the Wells score will determine if the 

patient commences the relevant DVT pathway and Enoxaparin via PGD ( appendix 4) 

administered 

The Nurse Practitioner in the Walk-in Centre will be responsible for -: 

Taking referrals from General Practitioners in Halton and St Helens PCT. 

Assessing and treating patients who self refer. 

Advising GP’s and other referring clinicians regarding suitability for treatment in the 

community. 

Providing advice and information to patients concerning their condition, treatment and 

follow up. 

Ensuring bloods drawn and transported in the agreed manner. 

Commencement of relevant DVT pathway on receipt of D-dimer results, if appropriate. 

Administering Enoxaparin as per PGD. ( Appendix 4) 

Referral to anticoagulant nurse.(appendix 2) 

Referral to Ultrasound. .(appendix 2) 

Discussing blood results with the anti coagulant nurse prior to the administration of the 

second dose of Enoxaparin. 

Referral to GP or other service as required. 

Maintaining accurate records. 

Planning education, training and continuing professional development. 

Ensuring that all staff using this policy act within The NMC Code and in accordance with 

the Standards for Medicines management. 

Liaising with the Clinical Governance team for the purpose of research and audit. 


Haematology Consultants will be responsible for: 

The medical care of the patients once they have commenced the DVT pathway. 

Informing and developing appropriate treatment and care pathways in collaboration with 

nursing staff. 

TRAINING REQUIREMENTS 

The PCT will ensure that all members of the Walk-In Centre staff providing this service will 

receive the necessary level of training for them to fulfil their individual responsibilities as 

identified in this policy. Training for the team regarding Wells assessment and the management 

of the patient on a care pathway is provided in house. Only those members of staff detailed in 

this Policy who have had specific training to deliver this service can undertake an assessment 

of patients presenting with a suspected DVT. 

DUTIES AND RESPONSIBILITIES 

Duties within the Organisation 

Duties and accountabilities of directors, committees, specialist staff, and authors with 

responsibility for procedural documents must be included within the document. 

Chief Executive 

The Chief Executive is responsible for ensuring compliance with the Hospital/PCT Policies and 

Guidelines, legislation, NHS guidance and for ensuring the policy is effective. 

Trust Board 

The Trust board is responsible for has overall responsibility for ensuring the provision of 

effective clinical services within the organisation, and to ensure that the Trust complies with its 

statutory obligations. 

All Halton & St Helens Staff 

All Staff are responsible for adhering to and complying with the requirements of the policies, 

guidelines, protocols and standard operating procedures (SOPs) contained within and 

applicable to their area of operation. 

Temporary and Agency Staff, Contractors and Subcontractors 

All Staff are responsible for adhering to and complying with the requirements of the policies, 

guidelines, protocols and standard operating procedures (SOPs) contained within and 

applicable to their area of operation. 


DOCUMENT STORAGE AND FILING 

The approved and ratified policy document will be uploaded to the document portal. Follow the 

link below to view the policy document and its related pages: 

http://sharepointcompliance/default.aspx 


REFERENCES 

Reference 

Michiels JJ, Gadisseur, Van der Planken M, 

Schroynes W, Berneman Z et al 

Diagnosis of Deep Vein Thrombosis: How many tests 

Do We Need? 

Acta chir belg 2005, 105, 16-25 

Patient Group Direction :Enoxaparin 2009; Halton and 

St Helens PCT, NHS Minor Injuries Walk in Centre. 

Wells PS Anderson DR, Rodger M, et al. Evaluation of 

d-Dimer in the diagnosis of suspected deep-vein 

thrombosis. N Engl J Med 2003; 349:1227 - 1235 

Wells PS Anderson DR, Rodger M, et al. Excluding 

pulmonary embolism at the bedside without diagnostic 

imaging: management of patients with suspected 

pulmonary embolism presenting to the emergency 

department by using a simple clinical model and d – 

dimmer . Ann Intern med. 2001;135: 98-107. 

Wells PS Anderson DR, Rodger M, et al. Wells score 

for Deep Vein Thrombosis. Lancet 1997; 350: 1795 - 

1798 

Page 9 of 40 

Relevance (whole 

document or 

section, please 

state) 

Whole 1a 

Whole 1v 

Whole 1b 

Whole 11b 

Whole 1b 

Evidence 

Grade

APPENDIX 1 

Glossary of Terms 

St Helens Minor injuries/Walk-In Centre – refers to the Millennium Centre where patients can 

self present or be referred without appointment for treatment of minor ailments and injuries. 

Widnes Walk-in Centre – refers to the Health Care Resource Centre where patients can self 

present or be referred without appointment for treatment of minor ailments and injuries. 

WIC- refers to St Helens Minor injuries / walk in centre or Widnes walk in centre 

DVT – refers to deep vein thrombosis. 

D-Dimer test – refers to the test carried out in the laboratory (or an onsite near patient testing 

machine) to confirm or exclude DVT. D-Dimer is a fibrin degradation product generated during 

fibrinolysis. D-Dimer concentrations are raised in the setting of acute deep vein thrombosis, and 

normal concentrations are expected in the absence of acute venous thrombosis unless other, 

coexistent conditions that activate the coagulant system are present. 

Wells score – refers to a clinical probability tool developed by Wells et al, (1995) which uses a 

structured assessment of explicit historical and physical assessment to stratify patients into low, 

moderate and high risk of deep vein thrombosis. 

Nurse Practitioner - refers to a nurse at the Walk-In Centre who have undergone specific 

training to assess patients and administer where appropriate Enoxaparin via a Patient Group 

Direction. 

Operational Policy – refers to the document, which guides the clinical professional through the 

DVT pathway (Appendix B). 

Patient Group Direction (PGD) is a written instruction to enable a healthcare professional to 

supply and / or administer a licensed medicine to groups of patients how may not be individually 

identified before presentation for treatment.( the majority of clinical care should be provided on 

an individual, patient-specific basis).This must be approved by a team, which includes, a 

Director, a Senior Doctor, a Senior Pharmacist 

PCT- refers to NHS Halton and St Helens Primary Care Trust 

ED – refers to Emergency Department Whiston Hospital 

GP- refers to General practitioner 


GPAU- refers to the GP assessment unit at Whiston hospital 

Single point access refers to out of hours GP that covers Halton and St Helens 

LFT,s refers to Liver Function Tests 

U+E,s refers to Urea and Electrolytes 

FBC refers to Full Blood Count 


APPENDIX 2 

REFERRAL FORM TO ANTICOAGULANT NURSES 

WHISTON HOSPITAL FROM THE WALK-IN CENTRES 

NAME……………………………………………. 

ADDRESS………………………………………... 

……………………………………………………. 

……………………………………………………. 

POST CODE……………………………………... 

DATE OF BIRTH ….../……../…….. 

TEL NO…………………………………………... 

NEXT OF KIN 

TEL NO…………………………………………... 

DATE OF REFERAL …../……/………. 

GP………………………………………………… 

ADDRESS……………………………………….. 

…………………………………………………… 

……………………………………………………. 

TEL NO…………………………………………... 

PATIENT’S WEIGHT………………Kgs 

PREVIOUS DVT YES/NO 

FAMILY HISTORY YES/NO 

EXCLUSION CRITERIA FOR WALK-IN CENTRE TREATMENT 

PATIENTS UNDER 16 YEARS OF AGE 

KNOWN ACTIVE CANCER 

SUSPECTED OR PREVIOUS PULMONARY EMBOLUS 

SOCIAL REASONS eg NOT INDEPENDENT, NO SUITABLE CARER 

NO ACCESS TO A TELEPHONE 

IV DRUG USER 

ALCOHOL DEPENDENT 

PREGNANCY & PATIENTS LESS THAN 6/52 POST PARTUM 

HISTORY AND RECORD OF BLOODS TAKEN 

D-DIMER RESULT…………………………………… 

CLINICAL STRATIFICATION LOW RISK MED RISK HIGH RISK 


YES/NO 

YES/NO 

YES/NO 

YES/NO 

YES/NO 

YES/NO 

YES/NO 

YES/NO

ENOXAPARIN (CLEXANE) 

DATE DOSE PRESCRIBED BY TIME GIVEN GIVEN BY 

DOPPLER REQUEST RIGHT LEG LEFT LEG 

DATE AND TIME …………………………………………………………………….. 

SIGNATURE………………………………… PRINT NAME…………………………………….. 


APPENDIX 3 

Click here to view and print the document 










APPENDIX 4 

GP 

Referral with letter and 

phone call 

Low * 

Clinical assessment 

inc. Wells criteria 

Risk 

stratification 

Medium * 

Halton and St Helens 

St. Helens NHS Minor Injuries/ Walk in Centre 

Widnes Walk in Centre 

Pathway for patients presenting with 

Deep Vein Thrombosis 

At the Walk-in Centre 

High * 

*Refer to separate pathways overleaf 


? DVT 

Self referral 

Clinical assessment 

Differential 

diagnosis 

Discharge

APPENDIX 5 

Negative D Dimer 

500 ng/ml 

Give 1 st dose Enoxaparin 

Prior to 2 nd dose 

Enoxaparin ensure: 

Refer to Anti Coagulation 

Nurse (ACN) for follow 

up. 

Blood results have been 

checked by practitioner

APPENDIX 6 


500ng/ml 

Give 1 st dose Enoxaparin 

Prior to 2 nd dose Enoxaparin ensure: 

Refer to Anti Coagulation Nurse (ACN) 

for follow up. 

Blood results have been checked by 

practitioner 

Arrange Doppler 


APPENDIX 7 


< 500 ng/ml 

Arrange: 

Referral to Anti Coagulation 

nurse (ACN) for follow up. 

Doppler 


St. Helens NHS Minor injuries / Walk-in Centre 


Medium Risk 

Well’s score 1-2 

D-Dimer FBC, U&E, LFT, Coagulation 

screen, Glucose (if diabetic). 

D Dimer result 


Positive D Dimer 

>500 ng/ml 

Recall patient for 1 st dose 

Enoxaparin 



Nurse (ACN) for follow up. 

Blood results have been checked 

by practitioner

APPENDIX 8 


< 500ng/ml 

Arrange: 

Referral to Anti 

Coagulation nurse 

(ACN) for follow 

up. 


St. Helens NHS Minor injuries / Walk-in Centre 


Medium Risk 

Well’s score 1-2 

D-Dimer 

FBC, U&E, LFT, Coagulation 


Send to Whiston 

Lab 

Results within 2 hrs 

Positive D Dimer 

>500ng/ml 

Recall patient for 1 st 

dose Enoxaparin 


Referral to Anti Coagulation Nurse 

(ACN) for follow up. 

Blood results have been checked 

by practitioner 

Doppler arranged 


APPENDIX 9 

Negative D-Dimer 

500ng/ml 


St. Helens NHS Walk-in Centre 



Refer to Anti Coagulation Nurse 

(ACN) for follow up. 


checked by ACN 

Arrange Doppler 


APPENDIX 10 

Negative D-Dimer 

190ng/ml 


St. Helens NHS Walk-in Centre 


Prior to 2 nd dose Enoxaparin 

ensure: 

Refer to Anti Coagulation 

Nurse (ACN) for follow up. 


checked by ACN 

Arrange Doppler

APPENDIX 11 


St. Helens NHS Minor injuries /Walk-in Centre 


High Risk 

Well’s score >3 

D- Dimer 

FBC, U&E, LFT, Coagulation 


Administer 1 st dose Enoxaparin 

Arrange: 



Doppler 

Prior to 2 nd dose Enoxaparin 

ensure: 


checked by practitioner 


APPENDIX 12 


St. Helens NHS Minor injuries /Walk-in Centre 


High Risk 

Well’s score >3 

D- Dimer FBC, U&E, LFT, 

Coagulation screen, Glucose (if 

diabetic). 

Administer 1 st dose Enoxaparin 

Arrange: 



Doppler 

Prior to 2 


checked by practitioner 

nd dose Enoxaparin 

ensure: 


APPENDIX 13 

Information for patients attending with 

Suspected Deep Vein Thrombosis 


St Helens MIU/WIC and Widnes WIC 

Your Doctor has referred you to the Walk-In centre because there is the possibility that you 

may have a blood clot in your leg. To find out if this is the case we will discuss with you how to 

diagnose your condition. This may include a physical examination, a blood test and possibly a 

scan of your leg at Whiston hospital. 

If we believe a blood clot is a strong possibility you may be offered an injection of a “blood 

thinning” drug called Enoxaparin. If a clot is present this helps to stop it from getting any larger. 

If you receive a scan of your leg, but we do not find a clot, an anticoagulant nurse will discuss 

with you your risk factors of having a clot. If you are felt to have risk factors the scan would 

usually be repeated in one week. 

If the scan finds a clot you would usually be started on Warfarin, another type of “blood 

thinning” drug. You would be offered education and information through the Anticoagulation 

Nurse at Whiston Hospital, and provide follow up by a consultant regarding your care and drug 

treatment. 

The risk factors of having a clot are: 

Previous clots 

Recent long haul flights 

Recent surgery 

Immobility 

Family history of clots 

Pregnancy (If you have a positive scan Warfarin will not be started, you will remain on 

Clexane). 

Please note that it is advised you do not drive until we have a diagnosis or you are pain free. 

We recommend you elevate your legs whilst sitting and gently mobilise – but if pain increases 

on exercise please rest. You are advised to refrain from sporting activities and may find it 

necessary to take time off work. 

Contact numbers for: 

Anticoagulant nurse, Whiston 0151 430 1845 

St Helen’s Minor injuries/ Walk-In Centre 01744 627400 

Widnes Walk in Centre Reception 0151 495 5000 


APPENDIX 14 


St. Helens Minor Injuries Unit/NHS Walk-in Centre 


Information for patients receiving Enoxoparin (Clexane) 

What is Enoxoparin? 

Enoxoparin belongs to a group of medicines called Low Molecular Weight Heparins. 

What is Enoxoparin used for? 

Enoxoparin is used to prevent unwanted blood clots from forming in veins and to break up blood 

clots that have already developed in veins. 

How is Enoxoparin given? 

Enoxoparin is injected under your skin. The nurse in the Walk-In Centre will administer 

your injection. 

The nurse will tell you when to attend for your next injection. 

It is important that you attend on the time and date arranged for any follow-up injections. 

Does Enoxoparin have side-effects? 

As well as benefits, a medicine may occasionally cause some unwanted effects in some 

patients. These are called side-effects. 

Side effects of Enoxoparin may include: 

Pain, bruising and mild local irritation at the site of injection. 

Rarely, hard nodules or lumps at the site of the injection, these usually resolve after a 

few days. 

Skin rashes 

Itching 

Bleeding disorders, bruising, pain or tenderness in your abdomen, joint pains. 

Rarely, hair loss. 

If you experience any unusual bleeding, develop any abdominal pain or feel unwell with any 

allergic skin rashes or difficulty breathing, attend Accident and Emergency immediately. If 

you have any questions or concerns regarding your treatment with Enoxoparin please ask 

the nurse at the St Helens Minor Injuries Unit/ NHS Walk-In Centre. 

OR 


Telephone: 

Anti-Coagulant Nurses on 0151 430 1845 (9am-5pm Mon-Fri) 

St Helens Minor Injuries Unit/NHS Walk-In Centre 01744 627400 

Widnes Walk in Centre 0151 495 500 

NHS Direct 08454647 


APPENDIX 15 

Click here to view and print the form 

NEW REFERRAL FORM 

FOR DIRECT ACCESS OF PATIENT WITH SUSPECTED DEEP VEIN THROMBOSIS 

St Helens MIU/WIC and Widnes WIC 

This form is an integral part of the DVT pathway and therefore should be completed in full. 

Failure to do so may result in the patient being referred back to original source depending on 

patient’s clinical need. 

PATIENTS DETAILS 

SURNAME FIRST NAME 

………………………………………. …………………………………… 

ADDRESS 

……………………………………………………………………………………………………………… 

……………………………………………………………………………………………………………… 

………………………………………………………… 

TEL NUMBER DATE OF BIRTH 

…………………………………… …………………………………. 

GP NAME / PRACTICE 

……………………………………………………………………………………………………………… 

……………………………………………………………………………………………………………… 

………………………………………………………… 

TEL NUMBER ……………………………………… 

Brief history of presenting complaint /problem 

……………………………………………………………………………………………………………… 

……………………………………………………………………………………………………………… 

……………………………………………………………………………………………………………… 

………………………… 

Are there any social factors that would prevent the patients frequent return ie mobility or 

transport 

issues……………………………………………………………………………………………………… 


……………………………………………………………………………………………………………… 

………………………………………………………… 

WELLS SCORE = ………….. 

Paralysis/paresis/plaster immobilisation of lower limbs +1 

Bedridden >3 days, major surgery in 4 hrs +1 

Active cancer – treatment in previous 6/12 or on palliative treatment +1 

Entire leg swollen +1 

Calf swollen >3cm (measure 10cm below tibial tuberoscity) +1 

L= ……….cm R = ………..cm 

Tenderness along deep veins +1 

Pitting oedema worse in symptomatic leg +1 

Collateral superficial vein ( non varicose) +1 

Alternative diagnosis more likely than DVT -2 

If a DVT is excluded, what management plan would you advise 

Home care Own Analgesia Review with GP in 24hrs 

Review with GP in 48 hrs ---------------------please circle 


APPENDIX 16 

Patients excluded from this service 

Surgery within the last 4 weeks yes 

Children under 16 years old yes 

Currently suspected of / previous pulmonary embolus yes 

Intravenous Drug user yes 

Alcohol Dependence yes 

Known diagnoses of malignant disease yes 

Pregnant and < 6 weeks post partum yes 

Known renal impairment yes 

Known hepatic impairment/ severe liver disease yes 

known bleeding disorder 

(haemophilia/thrombocytopenia) 

yes 

Pt who have had any type of stroke in the last 12 mths yes 

Pt who have had neuro or ophthalmic surgery after 

major trauma within the past 12 mths 

yes 

Pt who have diabetic retinopathy yes 

Pt with prosthetic heart valves yes 

Pt who have had an active oesophageal , gastric, 

duodenal ulceration in the last 12 mths 

Patients taking the following drugs area also excluded from the PGD and should be 

referred through usual channels (single point access/GPAU). 

Dipyridamole 

Dextran 

Thrombolytics 

Anti coagulation 

Drotrecogin alfa 

Iioprost 

Sibutramine 

Systemic glucocorticoids 

If you are unsure of whether the patient meets the criteria, please ring and speak to a member 

of MIU/WIC Team 01744 627403/627426 


yes

APPENDIX 17 

Patients excluded from community DVT service 

to be used in conjunction with PGD 

Surgery within the last 4 weeks yes 

Children under 16 years old yes 

Currently suspected of / previous pulmonary embolus yes 

Intravenous Drug user yes 

Alcohol Dependence yes 

Known diagnoses of malignant disease yes 

Pregnant and < 6 weeks post partum yes 

Known renal impairment yes 

Known hepatic impairment/ severe liver disease yes 

known bleeding disorder 

(haemophilia/thrombocytopenia) 

yes 

Pt who have had any type of stroke in the last 12 mths yes 

Pt who have had neuro or ophthalmic surgery after 

major trauma within the past 12 mths 

yes 

Pt who have diabetic retinopathy yes 

Pt with prosthetic heart valves yes 

Pt who have had an active oesophageal , gastric, 

duodenal ulceration in the last 12 mths 

yes 


Patients taking the following drugs area also excluded from the PGD and should be 

referred through usual channels (single point access/GPAU). 

Dipyridamole 

Dextran 

Thrombolytics 

Anti coagulation 

Drotrecogin alfa 

Iioprost 

Sibutramine 

Systemic glucocorticoids 


APPENDIX 18 

EQUALITY IMPACT ASSESSMENT TOOL 

To be completed with the policy document when submitted to the appropriate committee for 

consideration, approval and ratification. 

1. Does the policy/guidance affect one group less or 

more favourably than another on the basis of: 

Race NO 

Ethnic origins (including gypsies and travellers) NO 

Nationality NO 

Gender NO 

Culture NO 

Religion or belief NO 

Sexual orientation including lesbian, gay and 

bisexual people 

Yes/No Comments 

NO 

Age NO 

Disability - learning disabilities, physical disability, 

sensory impairment and mental health problems 

2. Is there any evidence that some groups are 

affected differently? 

3. If you have identified potential discrimination, are 

there any exceptions valid, legal and/or 

justifiable? 

4. Is the impact of the policy/guidance likely to be 

negative? 

5. If so can the impact be avoided? NA 

6. What alternative are there to achieving the 

policy/guidance without the impact? 

7. Can we reduce the impact by taking different 

action? 

If you have identified a potential discriminatory impact of this policy document, please refer it to 

Jenny Murphy, together with any suggestions as to the action required to avoid/reduce this 

impact. For advice in respect of answering the above questions, please contact Jenny Murphy. 


NO 

NO 

NA 

NA 

NA 

NA

APPENDIX 19 

DISSEMINATION AND TRAINING PLAN 

To be completed with the policy document when submitted to the appropriate committee for 

consideration, approval and ratification. 

The status column must be given a Red, Amber or Green rating with evidence to demonstrate 

an action has been completed. 

DISSEMINATION PLAN 

Title of document: 

Diagnosis and Treatment of Patients with 

a Suspected Deep Vein Thrombosis 

Policy 

Dissemination Lead: (Print name and 

contact details) 

Jenny Murphy 

Proposed action to retrieve out-of-date 

copies of the document: 

Date finalised: 

February 2010 

To be disseminated to: Disseminated 

by whom? 

TRAINING PLAN 

Previous document already being used? Yes (Please delete as 

appropriate) 

If yes, in what format and where? 

Paper Copy St Helens MIU/WIC 

Jenny 

Murphy 

Event (Please provide details of available training venues/dates to 

educate staff about this policy document) 


Timescale 

(Date) 

Within a 

month 

Training for staff will be provided in the MIU/WIC ( St Helens and Widnes ) 

in scheduled sessions 

Training Plan Lead (Please provide details of staff who will be 

responsible for overseeing this training) 

Jenny Murphy Advanced Practitioner 

Elaine McDowell Clinical Service Manager 

Additional information (Please provide details of any processes in place 

to support implementation) 

Status 

R A G 

Paper 

or 

Electronic 

Comments 

Timescale Owner Status 

R A G 

Denotes: Action not yet taken or deadline for action not met. Action plan to address this must be provided. 

Denotes: Action partially implemented. 

Denotes: Action complete.

Diagnosis and Treatment of Suspected Deep Vein Thrombosis

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