An audit and re -audit of adult venous thromboembolism risk assessment compliance with NICE guidelines in

the Medical for Older People department in University Hospital Southampton.

University Hospital Southampton

Introduction

Venous thromboembolism (VTE) is the third most common cardiovascular disease in the UK. 60% of VTEs are hospital-associated and cost the NHS £570,000 daily. The COVID-19 pandemic has highlighted the increased risks of VTE and reinforced the need for VTE risk assessment. As per the Department of Health, risk factors for VTE include age over 60, reduced mobility, dehydration and malignancy. All Medicine for Older People (MOP) patients have at least one of the aforementioned risk factors. A correct assessment prevents harm from VTE and also reduces the risk of bleeding from unnecessary pharmacological prophylaxis. The aim of this audit and reaudit was to assess the MOP departments compliance with completing the VTE risk assessment as per NICE guidelines [NG89].

Methods

The University Hospital Southampton (UHS) Adult VTE assessment is based on the Department of Health VTE assessment and additionally requires input of weight and renal function in order to guide prescribing. 100 consecutive MOP patients across 5 different wards formed the sample population in May 2021 for the audit and then again in December 2021 for the re-audit. Data was collected from the UHS electronic record, CHARTs. Three standards were selected; VTE risk assessed on day of admission, VTE prophylaxis appropriately prescribed for weight and renal function and re-assessment within 24 hours completed. These findings prompted the intervention of teaching sessions on the importance of VTE prophylaxis prescription, delivered to the MOP junior doctor team at a local meeting.

Results

44% of patients did not have a risk assessment completed within 24 hours of admission. This decreased to 5% in the re-audit.

4% of patients did not have appropriate prophylaxis prescribed according to renal function and 7% for weight in the audit. In the reaudit, this was 4% and 9% respectively.

94.5% of patients had no re-assessment done within 24 hours in the audit and 99% of patients in the re-audit.

Conclusion

Prescribing according to weight and renal function and reassessment remain an issue. With this re -audit, we wish to create a 24 hour re-assessment reminder popup on CHARTs and make a VTE assessment sticker which can be placed in patient notes to improve this. No patient developed a pulmonary embolism as a result of inappropriate VTE prophylaxis prescribing.