CLOTS AND COVID

Strategies To Minimise Thromboembolic Complications

Dr Zafraan Zathar, Dr Hanfa Karim; Dr Anne Karunatilleke, Dr May Yan and Dr Ziaudeen Ansari

Background

COVID-19 predisposes patient to higher incidence of both arterial and venous thromboembolic disease (VTE)1. COVID-19 complicated by VTE is associated with higher mortality, morbidity and longer hospital stay1,2 Those with severe disease, as defined by critical care admission or non-invasive ventilation, are most at risk1

AIM: Improve adherence to the evolving VTE prescribing practices locally and nationally, thereby, improving outcomes for COVID-19 patients.

Methodology

PDSA methodology was followed (Fig 1) to initially survey the prescribing practices over a 30 day period. Patients needing >40% FiO2 or bodyweight >80kg or other high risk factors for VTE (e.g cancer) were eligible for twice daily VTE prophylaxis.

Patients admitted to ITU or requiring respiratory support (i.e NIV) were eligible for extended VTE prophylaxis on discharge.

PLAN

What are the current prescribing practices?

PDSA 2

Retrospective review of all admitted patients over a 30 day period

Confirm if intervention has worked and identify any new areas for development

Review the data and hold focus groups to plan intervention

Retrospective review of newly admitted patients

PDSA 1

Targeted teaching (AMU & respiratory ward) and aide-mémoire poster

Compare findings with PDSA cycle 1

Focus on improving time to first dose VTE

Learning Points

Targeted teaching and flow charts are helpful interventions to ensure adherence to evolving clinical practice (Fig 2: 75% vs 91%)

A different strategy is required to ensure we minimise time between admission to first dose VTE (Fig 2: 86% vs 86%)

GOING FORWARD:

As thromboprophylaxis is traditionally given in the evening, patients admitted after 6pm are not being given STAT dose.

In PDSA 3, we aim to target intervention at admitting teams to reduce time before first dose.