Retrospective Clinical Audit of Adherence to a Protocol for Prophylaxis of Venous Thromboembolism in Surgical Patients

Abstract

ABSTRACT Background: Thromboprophylaxis after surgical procedures reduces the incidence of pulmonary embolism and deep vein thrombosis. In previous studies, adherence with recommended thromboprophylaxis guidelines has ranged from 13.3% to 94.0%. Objective: This clinical audit was conducted to evaluate the rate of adherence to the venous thromboembolism prophylactic protocol for surgical patients at the authors’ institution. Methods: A chart review was conducted for surgical patients admitted from April 2005 to March 2006. Patients were included if they had undergone an elective surgical procedure, had been under general anesthesia for more than 45 min, had been admitted to hospital for more than 48 h, and were over 40 years old. Patients were excluded if they had been admitted for medical reasons, emergency surgery, or orthopedic surgery or if they had received anticoagulation before the surgery. Each patient’s risk of venous thromboembolism was determined, and his or her thromboprophylaxis regimen was compared with the recommended regimen and assessed for adequacy. Results: Thromboprophylaxis was used for 82 of the 100 surgical patients whose records were reviewed. However, only 29% of the patients had received adequate therapy as defined by the prophylaxis protocol. The major reason for inadequacy of thromboprophylaxis was inappropriate stratification of the patient’s risk of venous thromboembolism. Conclusion: Most surgical patients had received a thromboprophylactic regimen, but a large proportion of the patients received therapy that was suboptimal for their assessed level of risk. Provision of a checklist for assessing the risk of thrombosis and education of practitioners about risk stratification and the benefits of prophylaxis might improve adherence rates. RESUME Historique : La thromboprophylaxie postchirurgicale reduit l’incidence d’embolie pulmonaire et de thrombose veineuse profonde. Dans des etudes anterieures, le taux d’observance des lignes directrices recommandees en thromboprophylaxie variait de 13,3 % a 94,0 %. Objectif : Cette analyse clinique a ete menee pour evaluer le taux d’observance du protocole de prophylaxie de la thromboembolie veineuse chez les patients operes, dans l’etablissement des auteurs. Methodes : Une analyse des dossiers medicaux des patients operes entre avril 2005 et mars 2006 a ete effectuee. Les patients etaient retenus aux fins d’analyse s’ils avaient subi une intervention chirurgicale non urgente, avaient recu une anesthesie generale pendant plus de 45 minutes, avaient ete hospitalises pendant plus de 48 heures et etaient âges de plus de 40 ans. Les patients n’etaient pas retenus s’ils avaient ete hospitalises pour des raisons medicales, pour une intervention chirurgicale urgente ou orthopedique, ou s’ils avaient recu une anticoagulotherapie avant l’intervention. Le risque de thromboembolie veineuse a ete evalue pour chaque patient et leur thromboprophylaxie a ete comparee a la thromboprophylaxie recommandee pour determiner si elle etait adequate. Resultats : On a eu recours a la thromboprophylaxie chez 82 des 100 patients operes dont les dossiers medicaux ont ete analyses. Cependant, seulement 29 % de ces patients ont recu une thromboprophylaxie adequate telle que definie dans le protocole. La principale raison expliquant l’inadequation de la thromboprophylaxie etait la mauvaise stratification des risques de thromboembolie veineuse des patients. Conclusion : La plupart des patients operes ont recu une thromboprophylaxie qui, chez une forte proportion d’entre eux, etait sous-optimale selon le risque evalue. L’utilisation d’une liste de controle pour evaluer le risque de thrombose et la formation des praticiens sur la stratification du risque et les bienfaits de la prophylaxie pourraient faire augmenter les taux d’observance.