Pooja S Nair
Introduction
The accuracy and consistency of Venous Thrombo-embolism risk assessment are fundamental to ensuring that patients receive appropriate preventive measures. VTE risk is dynamic. However, in day case surgeries, the approach to VTE prophylaxis must balance the risks of thromboembolism with the potential side effects of Low Molecular Weight Heparin. The duration of the pharmacological prophylaxis at discharge can be tailored, however, the need to be have some compliance to the guidelines is highly recommended. The aim of this audit is to understand the adherence of the extended pharmacoprophylaxis of VTE to the guidelines for the day case surgeries and the adequacy of the risk assessment documentation.
Methods
Type - retrospective study; 1st cycle
Data collection period - 3 months
Inclusion criteria - All day case general surgery cases above the age of 16 years done under anaesthesia
Sample size - 301
Results
- There was no documentation of VTE risk for 18 patients
- Pre-op VTE assessment document for only 36%
- 7% were failed day case patients; none of the had a VTE risk re-assessment at 24 hours
- 52 patients had no risk factors for VTE, 17% received LMWH postoperatively and 23 patients were documented in the operation notes as having risk factors
- 103 took post operative LMWH, 50% for 4 days.
Conclusions
The extended pharmacy-prophylaxis is unnecessary in some cases, adds burden to community services. There is gap in documentation.
The main recommendations:
Standardise the duration of LMWH therapy
Strengthen the documentation practices
Clarify "cohort group" definitions
Standardise 24-hour risk re-assessment in failed day cases
Authors
Ms Pooja Syamala Nair
South Tyneside and Sunderland NHS Foundation Trust, South Shields, United Kingdom
Mr Balamurugan Ganesan
South Tyneside and Sunderland NHS Foundation Trust, South Shields, United Kingdom
Dr Abdul Rehman Qazi
South Tyneside and Sunderland NHS Foundation Trust, South Shields, United Kingdom
Dr Alexandra Hudspeth
South Tyneside and Sunderland NHS Foundation Trust, South Shields, United Kingdom