Preventing and treating clots

Thrombosis UK VTE Awards

Application form

Applications are accepted on the basis that Thrombosis UK can share the content with external judges who will assist us with assessments. Service models, resources and working processes of successful Thrombosis UK VTE Award winners will be uploaded to the Thrombosis UK website and shared via publications, social media, and other opportunities.

When completing your application form, you should use lay language and answer each question in a concise manner.

Please keep to any word limits given.

All sections need to be completed, if any section is removed, omitted or incomplete, we cannot process the application.

Applications need to be submitted via email to: [email protected] You will receive a notification of receipt within 48 hours of submission. If you do not receive a notification, please email [email protected]

The closing date for applications is 1st February 2025

We are unable to consider late applications.

Section 1

Section 1.1

Service title / resource(Required)

The title should be short and descriptive, and not exceed 30 words

Lead Organisation Name(Required)

Lead Organisation Phone Number(Required)

Lead Organisation Email Address(Required)

Type of organisation See note below*(Required)

Primary Contact Name(Required)

First Last

Primary Contact Phone Number(Required)

Primary Contact Email Address(Required)

Partner organisation(s) if applicable

Team members (if applicable)

Name and title of each individual

*You should tell us what type of organisation is leading the service. The organisation named here should be the organisation within which the service is being delivered and must provide or deliver health services free at the point of care in primary, secondary or tertiary care, or across boundaries such as health and social care. If you are a non-NHS provider of health services, the organisation must be commissioned or in an authorised position to provide an anticoagulation service (eg registered with Care Quality Commission in England). You should provide a statement that more than 25% of your work is with NHS funded patients (we may require evidence to this effect)

Section 1.2

Length of time the service / resource / your involvement, has been operating(Required)

Section 2

Section 2.1

Please provide an overview of the DVT service (500 words)(Required)

Please provide a summary of the work undertaken to address identified issues. Please use lay language.
Please avoid use of unexplained acronyms. You should include a summary of the challenges and explain how your service / resources / work, has addressed these. You should also describe the specific and tangible improvements that the area of work has attained and the key measures used to evidence your improvements.

Section 2.2

Please provide information about the embedding of the service and collaboration between centres involved (max 500 words)(Required)

Section 2.3

Please include evidence that examples the benefit, positive impact, and achievement the service has achieved (500 words limit).(Required)

This should include:
i. How the service being described has incorporated guidance from NICE
ii. Evidence of regular auditing and actions as a result of this
iii. Your patient feedback and compliments & complaints procedure, giving examples of how you gather, measure and monitor patient feedback

Section 2.4

Please give examples of how your service supports new and existing staff sustain the service to exemplary standards. (300 words)(Required)

Please note: More weight will be attributed to candidates who can provide evidence of effectiveness

Section 2.5

What is innovative about your service and what evidence do you have to support this? (300 words)(Required)

Please note: More weight will be attributed to candidates who can provide evidence of effectiveness

Section 2.6

Please describe the audit measures you collect, how you do this and the review and subsequent action that then follows as a result. (400 words)(Required)

Please note: More weight will be attributed to candidates who can provide evidence of effectiveness

You should detail:
• what measure
• which measures and indicators you use
• how the data is collected
• the frequency of when the data is collected
• who within the project team is responsible for this

The success indicators should be shown stated with their measurement
Issues should also be included and the actions taken as a result.

Section 2.7

How do patients and the NHS benefit for your service? Provide summary in no more than 200 words(Required)

Please note: More weight will be attributed to candidates who can provide evidence of effectiveness

Declaration

To comply with the General Data Protection Act, we require your consent for Thrombosis UK to use personal data supplied by you in the processing and review of your award application and in any other legitimate activity related to the Thrombosis UK VTE Awards. We will seek your permission to publish a summary of your activity prior to any publication. We require your assurance that personal data about any other individual included in the award application is supplied to us with their consent.
The signatory below will provide this consent and assurance. The signatory below also confirms that the information provided in the application form is accurate.

A senior representative (for example the chief executive or equivalent role) must sign the declaration below:
‘I confirm that I have read and fully support this application and confirm the information shared to be accurate and true.”

Name(Required)

First Last

Job Title(Required)

Organisation(Required)

Signature(Required)

Date(Required)

Primary contact from the service provider (named in section 1.1)

Name(Required)

First Last

Job Title(Required)

Organisation(Required)

Signature(Required)

Date(Required)

DATA PROTECTION

Thrombosis UK has a strict data protection policy that complies with UK data protection law.

Your name and contact details may be stored for up to 12 months in order for correspondence relating to your application be appropriately processed.

We wish to make you aware that your name and contact details, as included on your completed application form, will be viewed by the Thrombosis UK appointed Judging Panel solely for the purpose of reviewing and assessing your completed application. If your nomination is short listed, a representative from Thrombosis UK will then seek your permission to include your name on the summary paragraph included in the awards brochure and on the Thrombosis UK website.

Thrombosis UK takes security and confidentiality very seriously. Your name and contact details will never be passed or shared with any third party or an unauthorised individual. If you have any queries, please contact: [email protected]

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