Venous Thromboembolism Risk Assessment and Prophylaxis: An Audit-Based Study

Venous thromboembolism (VTE), mainly deep vein thrombosis (DVT) and pulmonary embolism (PE), persists as a critical contributor to hospital-acquired mortality. Despite its largely preventable nature, early 2024 data from Bon Secours Hospital in Cork revealed alarmingly low compliance with VTE prophylaxis protocol.

This study evaluated the implementation efficacy of VTE risk assessment and prophylaxis in adult hospitalised patients at Bon Secours Hospital, Cork, according to National Institute for Health and Care Excellence (NICE) guidelines.

Adult patients (127) at increased risk of VTE, specifically individuals aged ≥60 years, patients undergoing major surgical procedures, and/or patients with comorbidities including active cancer, hypertension, diabetes, immunological disorders, immobility or haematological disorders, across nine wards were included in this study. We also checked for any kind of bleeding risk, like active bleeding or low platelets. Each point was given 1 mark if present, which added to increase risk of VTE. We analysed the data to check the compliance with accurate prescription and completeness of the forms according to the NICE guideline. Exclusion criteria included paediatric, gynaecological, day-case admissions, and discharges within 24 hours of admission. The incomplete/inaccurate risk assessments were reported to improve timely and correct prophylaxis prescription.  Results: Compliance surged with assessment completion, reaching 111 out of 127 (87.39%) with prescription accuracy. Timely assessments within 24 hours accounted for 101 (79.52%), yet 16 (12.64%) remained unassessed. A substantial proportion (103, 80.23%) exhibited one or more VTE risk factors, predominantly advanced age and multiple comorbidities. Anticoagulants, particularly tinzaparin, constituted the principal prophylactic measure, with mechanical prophylaxis employed in only 15 (11.81%). Alarmingly, 22 (17.32%) of high-risk individuals were not prescribed any form of prophylaxis.

This study underscores the transformative impact of enforced protocol adherence and targeted multidisciplinary staff education on VTE prevention. The integration of an electronic health record system with real-time prompts could further ensure prophylaxis within the critical 24-hour window.