TH8.5 VTE Pharmacological Prophylaxis in Oesophagogastric Cancer Resection Patients: A Triple Cycle Closed Loop Audit Against NICE Guidance NG89

Abstract

Abstract Aims NICE NG89 Guidance introduced in 2018 recommends 28 days extended VTE pharmacological prophylaxis in patients who have major abdominal surgery for cancer. In 2018, our oesophagogastric unit protocols prescribed only inpatient VTE prophylaxis. Through the interventions of clinician education and modified unit protocols we improved our unit's compliance with NICE NG89. Methods We conducted a three cycle hybrid audit. 50 patients who underwent either oesophagectomy or gastrectomy were randomly chosen from 2017–19 (Cycle 1), 2019–21 (Cycle 2) and 2021–22 (Cycle 3). The first cycle intervention was the requirement for 14 days postoperative VTE pharmacological prophylaxis. The second cycle intervention increased this requirement to 28 days. All cycles additionally had interventions of clinician education. Results Against the NICE NG89 recommendation for 28 days postoperative pharmacological prophylaxis, our audit showed 14% compliance in Cycle 1, 26% in Cycle 2 and 91% in Cycle 3. The median duration of VTE prophylaxis prescription (combined inpatient and outpatient) was 7 days in Cycle 1, 23 days in Cycle 2 and 28 days in Cycle 3. The correct dose by weight for VTE prophylaxis was prescribed in 89% of cases in Cycle 1 and 100% of cases in Cycle 2 and 3. Whilst small numbers preclude statistical analysis, there were 2 bleeding events and 1 VTE event in both Cycles 1 and 2 but none in Cycle 3. Conclusions Our unit made a stepwise improvement against the NICE NG89 recommendation for extended VTE prophylaxis in cancer resections. Furthermore, clinician education improved correct weight based dosage.