Aim: This audit evaluates current practice of VTE prophylaxis in short term surgical patients at New Cross hospital and judges its success against national targets
Background: Venous thromboembolism (VTE) is a common complication of surgery which can be life threatening. Venographic studies have given evidence that the incidence of deep vein thrombosis (DVT) is raised in surgical patients who are not given prophylaxis. Pulmonary embolism is another serious manifestation of VTE which is known for its non-specific nature, and can be responsible for 28% of hospital mortality.
Method: Manual data collection was performed prospectively in a set time period between October and November 2010. Proforma were designed to enable efficient recording of variables such as VTE risk factors, Autar scale, ASA Grade and details of prophylaxis type.
The patient sample was reduced to 94 from 100 after application of exclusion criteria. The total number of patients assessed to be at-risk was 67. The remaining patient sample was not excluded because secondary analysis was to be done. Exclusion criteria include patients undergoing local anaesthetic procedures only, patients below 18 years and those with a diagnosis of VTE, among others.
Patients were identified as at-risk upon fulfillment of one or more of the NICE criteria. Definitions of standards being met ‚completely‘, ‚partially‘ and ‚not at all‘ were formulated for the purpose of this audit. Day case patients eligible for VTE prophylaxis constituted the majority of the sample (47), followed by short (15) and overnight stay (5).
Standard: In discussion with the Consultant Anaesthetist, the standard of NICE Guideline implementation was determined at 80%.
Results: Overall, it was found that standards were ‘completely’ met in 13% cases, ‘partially’ met in 15% and ‘not met’ in 72% patients. When split by surgical admission type, we found that 85% of at-risk day case patients did not receive any prophylaxis. In contrast, practice amongst short stay patients revealed the lowest non-compliance with NICE guidance, at 27%. Best practice was seen in short stay patients with nearly half of those at increased risk of VTE (47%) having received ‘complete’ prophylaxis.
Conclusion: Overall, current practice does not meet the standards set in this audit-only 28% of patients at increased risk received a form of prophylaxis. Guidance was worst followed among day case patients. Conversely, practice was closest to set standards of 80% in short stay patients.