A re-audit of prevention of venous thromboembolic disease in medical and surgical hospital patients in a single university teaching hospital

Abstract

The importance of the prevention of venous thromboembolic events (VTEs) among medical and surgical hospital patients is coming more and more to the fore with the ongoing development of initiatives and recommendations across the globe. As readers of this journal will note, we have previously carried out an audit of the level of VTE prophylaxis among patients at our hospital in October 2009 [1]. This led to the development of on the ward reminder notices highlighting VTE prophylaxis. As a follow-up to our previous work we reaudited in October 2010 to assess the impact of on the ward VTE reminders. On a designated day during October 2010, all medical and surgical in-patients at the South Infirmary Victoria University Hospital, Cork were assessed regarding VTE prophylaxis. A proforma, identical to our previous proforma, was used to assess patients, with data collection being from patient case notes and medication prescription charts. Proforma preparation was as per current European VTE prophylaxis guidelines. Medical and surgical teams were not aware that the audit was taking place to avoid bias changes in management behavior, while audit approval was prospectively received from the hospitals Drugs & Therapeutics committee. Eighty percent (97/122) of in-patients were included in the study, with the remaining 20% (n = 25) being either inaccessible for inclusion (n = 10), had a contraindication to VTE prophylaxis (n = 4: active bleeding disorder) or already receiving therapeutic anticoagulation (n = 11). Fifty percent (n = 49) were female and 50% (n = 48) male, with a mean age of 67.9 years. The modal length of hospital stay at review was 3–7 days. Forty percent (n = 39) of patients received VTE prophylaxis and 25% (n = 24) were using TEDS. Among those on VTE prophylaxis medication, 41% (n = 16) received Tinzaparin Sodium 3,500 units, 38% (n = 15) enoxaparin 20 mg and 21% (n = 8) enoxaparin 40 mg. Four patient received VTE prophylaxis at 08.00 hours, 3 at 13.00 hours and the remaining 32 at 22.00 hours. Among the patients included in this audit 50 had a medical indication for VTE prophylaxis and 23 had a surgical indication. No patient had both medical and surgical VTE prophylaxis indications. Fifty-three percent (39/ 73) of patients with a clear indication for VTE prophylaxis were appropriately receiving such. Sixty-five percent (15/ 23) of surgical indications were appropriately covered by VTE prophylaxis compared to 48% (24/50) of medical indications. No patient received VTE prophylaxis without an indication. Based on the findings of this audit we have seen an improvement in appropriate use of VTE prophylaxis correlating with the use of ward notices highlighting VTE E. O’Sullivan, A. Ni Laoire, C. Buckley, H. Bastaki, M. Walsh and N. A. M. Jaffar are joint second authors.