Abstract
BackgroundVenous thromboembolism (VTE) prophylaxis in an important aspect of the care of hospitalised patients, for which the National Institute for Health and Care Excellence (NICE) has issued guidance. Guidance compliance continues to be a concern. Junior doctors are the main group responsible for prescribing thromboprophylaxis. We aimed to compare local pharmacological thromboprophylaxis prescribing against NICE guidelines in a surgical department at a district general hospital, and determine whether interventions aimed at improving compliance were effective.MethodsOver four months, a two cycle audit of prescribing patterns for VTE prophylaxis was performed using data collected at four intervals: 1. Baseline 2. Following pro-forma introduction and feedback 3. A second baseline data collection. 4. Following VTE prophylaxis teaching.ResultsA total of 394 admissions were included. Correct identification and prescribing for at-risk patients ranged between 76 and 93 %, whilst risk assessment documentation and explanation to patients occurred in fewer than 50 and 66 % respectively. Prescribing and risk assessment improved in the first cycle (chi2 = 6.75, p = 0.009 and chi2 = 10.70, p = 0.001 respectively), a consequence of one specialty improving following additional feedback. Teaching was not associated with improvements. Overall compliance with NICE guidelines was achieved in no more than 25 % of admissions.ConclusionsDespite junior doctors generally prescribing VTE thromboprophylaxis appropriately, overall compliance with guidelines remained poor regardless of educational interventions. Verbal feedback was the only intervention associated with modest improvements. A pressurised work environment may limit the impact of educational interventions. Guidance simplification or devolving responsibility to other members of staff may improve compliance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1480-9) contains supplementary material, which is available to authorized users.
Highlights
Venous thromboembolism (VTE) prophylaxis in an important aspect of the care of hospitalised patients, for which the National Institute for Health and Care Excellence (NICE) has issued guidance
The National Institute for Health and Care Excellence (NICE) has developed guidelines outlining the best practice for reducing the risk of VTE in hospitalised patients, which include the prescribing of pharmacological thromboprophylaxis in the form of anticoagulation for at-risk patients, [2]
Compliance with all key aspects of VTE guidance was achieved in approximately 25 % of patients
Summary
The National Institute for Health and Care Excellence (NICE) has developed guidelines outlining the best practice for reducing the risk of VTE in hospitalised patients, which include the prescribing of pharmacological thromboprophylaxis in the form of anticoagulation for at-risk patients, [2]. Campaigns such as the ‘1000 lives plus’, used by our unit, have sought to raise awareness of this. Educational interventions for new prescribers, relevant to the junior doctors responsible for the majority of prescribing in VTE prophylaxis, generally prove positive, but audit and feedback have been demonstrated to positively influence practice, it is unclear as to which interventions are most effective [13, 14]
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