Shared learning database

South London Healthcare NHS Trust
Published date:
October 2012

Following an initial audit in February 2011, the team at South London Healthcare Trust (SLHT) undertook a re-audit to assess if Venous Thromboembolism (VTE) risk assessment had taken place, to check if the appropriate thromboprophylaxis was prescribed and given and to establish if the patient had been provided with sufficient information about VTE. The audit was done in patients admitted Jan 2012 to April 2012.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

Assess if the VTE risk assessment has been completed at admission and at 24 hours
- Check if the appropriate thromboprophylaxis prescribed and given according to NICE CG92 (2010).
- Is there documented evidence that the patient has been given verbal and written information on VTE

Reasons for implementing your project

VTE is a common complication amongst hospital patients with potential to cause significant morbidity and mortality. Estimated 25,000 patients in the UK die from preventable hospital-acquired VTE every year. The Government has estimated that VTE complications are costing over £600 million a year. VTE is quite preventable in many cases if appropriate thromboprophylaxis is given.

A previous audit took place in February 2011 with the following recommendations for action:

-Move the VTE risk assessment form to the drug prescription charts
-High level reminders of the need to complete VTE risk assessment forms from the Chief Executive, Medical Director and Director of Nursing
-Increased engagement from all consultants during ward rounds to ensure VTE risk assessment forms are completed
-Increased awareness for nursing staff to ensure their patients have a completed VTE risk assessment form
-Development of local, ward based initiatives to ensure patients with an uncompleted VTE risk assessment form are followed up in a timely manner

How did you implement the project

100 medical & 100 surgical patients at Queen Elizabeth Hospital, Woolwich and at the Princess Royal University Hospital, Orpington were included in the re-audit.

Retrospective assessment post discharge was carried out in patients admitted between Jan 2012 and April 2012. A sample of patient notes were selected randomly.

Standardised proforma was filled in using data from drug charts, discharge summaries, patient notes and pre-assessment documentation.

Data was entered from the proforma into Microsoft Excel spreadsheet. Appropriateness of the thromboprophylaxis was ascertained by two experienced Haematology Thrombosis Consultants. Analysis of the data was undertaken using Microsoft Excel. Further information can be found in the slide set in supporting information.

The project did not incur any extra costs.

Key findings

Assess if risk assessment has been completed:
- Feb 2011: 48% had at least 1 completed VTE risk assessment
- Now 78% had at least 1 assessment completed in the 1st 24 hrs
- Now 30% had VTE risk assessment repeated at 24 h (previous audits < 5%)
Check if the appropriate thromboprophylaxis prescribed and given:
- Appropriate type of thromboprophylaxis 81%
- Appropriate dose of pharmacological thromboprophylaxis 82%
- Appropriate dose of duration thromboprophylaxis 87%
It was difficult to ascertain if patients prescribed mechanical prophylaxis were actually given this.
Is there documented evidence that the patient has been given written and verbal information on VTE?
- Difficult to assess appropriately as there is no unified place to document information being given to patients at admission or at discharge.

Key learning points

-Numbers and types of patients. The conclusions are limited to a broad group of patients. Therefore any actions taken from the results would be general and not specifically targeted to specific problem areas.
-Audits with reasonable number of patients taken in each medical or surgical speciality would allow specific issues to be addressed.
-Accuracy of VTE risk assessment not assessed. To address how accurately the VTE risk assessments are completed would require prospective audits so that all relevant patient information would be available when the patient is admitted.
-Difficulty in accessing all the information required. For example: documentation of VTE education, documentation of contraindications to mechanical thromboprophylaxis, documentation of information given to patients. Retrospective audits may not have all of the information available in the patient notes.
-A lack of documentation does not equal lack of assessment/administration of prophylaxis. Patients may still receive appropriate thromboprophylaxis but if documentation is poor then this would reduce the % of appropriate thromboprophylaxis. Cross-sectional audits would address this.

We do not know that different criteria have been assessed. (Weight, renal function, platelets and ALT). In determining the appropriateness of thromboprophylaxis it was difficult to ascertain how well these factors were assessed in a retrospective audit.

QEH discharge summary and take home medications paper based. This made it more difficult to do the audit compared to having an electronic discharge summary which was available at the PRUH.

Contact details

Dr Bipin Vadher
Consultant Haematologist
South London Healthcare NHS Trust

Primary care
Is the example industry-sponsored in any way?