Quality standard

Quality statement 1: Timing of pharmacological venous thromboembolism prophylaxis

Quality statement

People aged 16 and over who are in hospital and assessed as needing pharmacological venous thromboembolism (VTE) prophylaxis start it as soon as possible and within 14 hours of hospital admission. [2010, updated 2021]

Rationale

VTE risk assessments are carried out for most people admitted to hospital, but the results are not always acted on promptly, meaning that pharmacological prophylaxis can be delayed and the risk of hospital-acquired thrombosis increased. Ensuring that prophylaxis is started as soon as possible and within 14 hours of hospital admission for medical, surgical and trauma patients will reduce the chance of VTE.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of arrangements to ensure that people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis start it as soon as possible and within 14 hours of hospital admission.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from service protocols and prescribing systems.

Process

Proportion of people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis who start it within 14 hours of hospital admission.

Numerator – the number in the denominator who start pharmacological VTE prophylaxis within 14 hours of hospital admission.

Denominator – the number of people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Rates of hospital-acquired thrombosis (HAT).

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The Royal National Orthopaedic Hospital, NHS England and NHS Improvement's GIRFT Thrombosis Survey includes the number of HAT cases.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that written clinical protocols are in place so that people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis start it as soon as possible and within 14 hours of hospital admission. They also have clinical protocols on considering an adjusted dose of low molecular weight heparin (LMWH) for people who are at extremes of body weight or have impaired renal function. They ensure that they have healthcare professionals available to carry out the assessment and prescribing systems designed to start VTE prophylaxis within this timeframe.

Healthcare professionals (such as pharmacists, advanced nurse practitioners and doctors) prescribe pharmacological VTE prophylaxis to people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis. They discuss the medicine with the person and involve them in making decisions about it, and give them verbal and written information on the importance of using pharmacological VTE prophylaxis correctly and possible side effects. They make sure that the person starts treatment as soon as possible and within 14 hours of hospital admission. For people at extremes of body weight or with impaired renal function, they consider adjusting the dose of LMWH in line with the summary of product characteristics and locally agreed protocols.

Commissioners (clinical commissioning groups) ensure that services have written clinical protocols in place for people in hospital who are assessed as needing pharmacological VTE prophylaxis to start it as soon as possible and within 14 hours of hospital admission. They also ensure they have clinical protocols on considering an adjusted dose of LMWH for people who are at extremes of body weight or have impaired renal function. They ensure that services have healthcare professionals available to carry out the assessment and prescribing systems designed to start VTE prophylaxis within this timeframe.

People aged 16 and over who are in hospital and who need medicine to prevent blood clots start taking the medicine within 14 hours of being admitted to hospital. People who have a very low or high body weight or whose kidney function is impaired have the dose of medicine they are given adjusted. They discuss the medicine with a healthcare professional and make decisions about taking it. Their healthcare professional explains and gives them written information about how to use the medicine and any possible side effects.

Definition of terms used in this quality statement

People aged 16 and over who are in hospital

This includes medical, surgical and trauma patients. NICE's guideline on venous thromboembolism in over 16s, sections 1.4 to 1.15, should be referred to for population-specific recommendations on different timings and types of pharmacological VTE prophylaxis.

[NICE's guideline on venous thromboembolism in over 16s, recommendations 1.1.4, 1.1.6 and 1.1.7]

Hospital admission

Admission as an inpatient, where a bed is provided for 1 or more nights, or admission as a day patient, where a bed is provided for a procedure including surgery or chemotherapy but not for an overnight stay.

[NICE's guideline on venous thromboembolism in over 16s, terms used in this guideline]

Equality and diversity considerations

The supporting information for this statement highlights that people should be given verbal and written information on using VTE prophylaxis correctly and the possible side effects. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. For people with additional needs related to a disability, impairment or sensory loss, information should also be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.

Heparins are a type of pharmacological prophylaxis used to prevent VTE. They are of animal origin and this may be of concern to some people because of religious or ethical beliefs. The suitability, advantages and disadvantages of alternatives to heparin should be discussed with the person.