VTE Prophylaxis In Urology Patients - Preventing The Need To AnticoagulateThe Patient With Haematuria

Dr Alexander Morgan Kingston Hospital NHS Foundation Trust Corresponding address: a.morgan10@nhs.net

Introduction

Most hospitals in the United Kingdom have systems in place that ensure a patient's venous thromboembolism (VTE) risk is assessedon admission. Thirty percent of patients that are admitted under Urology via the emergency department present with haematuria.

Often anticoagulation is held. Failure to restart when bleeding has subsided can put patients at risk of the complicated and potentially catastrophic situation in which anticoagulation is needed to treat VTE in a patient with ongoing or at high risk of bleeding.

At our centre, a VTE prophylaxis assessment tool is used that must be completed for all patients on admission. Often Urological regular anticoagulation is intentionally heldor they are not started on prophylactic anticoagulation. Since this is only formally assessed at the beginning of their admission, we noticed that occasionally there were delays in their pharmacological VTE prophylaxis or regular anticoagulation being started.

Aims

Using the NICE guidelines on VTE prophylaxis: All patients to be assessed repeatedly and the correct anticoagulation decision to be made.

To assess whether prophylaxis, using a specifically designed section of the teams list, improved the quality of this prescribing.

Methodology

Data was collected retrospectively record and the normal teams patient lists.

The patients were assessed as to whether they had their VTE prophylaxis prescribed (both mechanical and pharmacological).

Results

The re-audit used the same methodology to see if there was an improvement in the quality of VTE prophylaxis prescribing.

We identified that a potential way to improve our prescribing was by adding an additional column to the teams patient list that encouraged the team to continuously assess the VTE prophylaxis used with each patient. Rather than just on admission.

Lessons learnt for continued improved VTE prophylaxis prescribing.

Suggestions made and discussed with team at local governance meeting

The percentage of patients prescribed pharmacological VTE prophylaxis appropriately remained similar 90% compared to 94%

What We Learnt

The addition of the new column has increased prescribing of mechanical VTE prophylaxis.

This addition of the new column has not improved our pharmacological prescribing of VTE prophylaxis.

Acknowledgements

We would like to thank the Urology team of Kingston General Hospital for their guidance through this audit.

References

(Overview | Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism | Guidance | NICE, 2018)

From discussing with the team, they felt that in general they were more aware of VTE prophylaxis prescribing for each patient. There was always some debate as to the best time to restart pharmacological VTE prophylaxis after episodes of haematuria. We suggested the following interventions to reduce delays in prescribing.

Encourage the patient to mobilise as soon as possible

Ensure mechanicalVTEprophylaxis is prescribed if indicated

Ensure patient remains well hydrated

Senior to assess each day and make the risk/benefit decision to whether or not to start pharmacological VTE prophylaxis

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Acknowledgements: Jane Runnacles