Re-audit: NG89 Venous thromboembolismreducing the risk for patients in hospital

Dr. Vasiliki Bisbinas (FY2), Dr. Imogen Pulley (FY2), Hanna Tunbridge (Clinical Audit Lead)

Background: Venous Thromboembolism (VTE) is the primary cause of preventable deaths in hospital, (25,000 deaths/year in the UK with 55-60% occurring during or following hospitalization). Psychiatric inpatients may be at higher risk due to reduced mobility, poor fluid intake, restraint, catatonia, sedation and antipsychotic use. Evidence suggests anti -psychotic use may be an independent risk factor for developing VTE. Comprehensive VTE risk assessment completed on admission and reviewed regularly is necessary. The NICE audit standard is a 100% rate of VTE assessments on admission.

Aim: Ensuring staff adhere to the NICE guidelines when caring for patient’s who are at risk of VTE

Past compliance: 68% (Dec 2019), 76% (Sept 2019)

Materials/Methods: The sample was collected via Rio ePMA and included all patients who were discharged from the Trust’s mental health inpatient units during 1-30th September 2021 (n=58) and evaluated against an online audit tool devised using criteria taken from the NICE guidance NG89 created by the Trust’s clinical audit team.

Results:

Compliance for the 14 audit criteria:

Ø 6 >90% (green)

Ø 2 80-89% (amber)

Ø 6 <80% (red)

Discussion:

• Overall compliance improved since 2019 audit: 82%

• Consideration of VTE risk within 24 hours of admission in clerking documentation was accepted as assessment of VTE risk - on many occasions the editable letter for VTE assessment as per protocol was not completed and uploaded to the patient’s electronic file

• Only 3/48 patients were assessed as at risk of developing VTE so some questions were only relevant to a very small number of patients

Conclusion:

• Highlighting the importance of VTE assessment in psychiatry at Junior Doctor inductions

• Remind Junior Doctors of the need for the completion of VTE assessment on admission for all patients and throughout the admission as clinically indicated

• VTE has now been integrated into Rio - no editable letter/easier input

• Re-audit is recommended – (started April 2022)