Implementing NICE guidelines on risk assessment for venous thromboembolism: failure, success and controversy

Venous thromboembolism (VTE) prophylaxis guidelines were originally published by the National Institute of Clinical Excellence (NICE) in April 2007. Controversy eclipsed their release. Consequently, the VTE prophylaxis publication was reviewed and republished in January 2010. The NICE guidelines recommend that all patients are assessed for risk before pharmacological prophylaxis is offered and reassessed at 24 hours to check adverse reactions; and that prophylaxis is appropriate. This paper aims to look at their implementation.

A prospective audit and re-audit in one orthopaedic department was completed to see how well the new guidelines were adhered to, find out first-hand what problems there were, and how they might be remedied.

Audit and re-audit highlighted that attaching an assessment tool to drug charts is plausible.

The study was limited to one centre and used a relatively weak research design.

As a process, the clinical impact of risk assessment for VTE is questionable as many patients will be high risk. Removing reassessment at 24 hours from the NICE guidance is recommended.

The authors put the NICE guideline into clinical practice, demonstrating how effectively it can work with their method, but also highlighting its flaws.