Various modes used to reinforce NICE guidance for venous thrombo-embolism prophylaxis

We aimed to demonstrate training and feedback are the cornerstones for success of a hospital and its clinical policies whilst supporting development and progression of trainees. We achieved the above by monitoring the assessment and documentation of venous thrombo-embolic (VTE) risk and check its compliance with NICE guidelines by prescription of appropriate VTE prophylaxis. 1. To reinforce implementation of NICE guidance for venous thromboembolism prophylaxis. 2. To demonstrate that any published guideline meets its success when it is imparted clearly to the individuals responsible for implementing it. Also with continuous flux of junior doctors and their rotation in clinical firms, it is imperative that the hospital clinical practice is regularly audited and the results fed-back for negative or positive criticism.

We performed a baseline audit of the hospital practice for venous thrombo-embolic risk assessment and appropriate prescription in all surgical patients. It demonstrated low compliance of 67 to 85% for assessment of the risk and 87 to 96% for prescription of prophylaxis in individual wards, requiring compulsory improvement in practice.

We applied written, verbal and visual mode of training to encourage adherence to the VTE policy. 1. Notice-board posters in wards, theatres and doctor's mess; demonstrating ward based poor results of the baseline audit. 2. Trust 'computer information technology services' helped publish a screen saver based reminder about the anticoagulation policy recommendations on all networked computers. 3. E-mails circulated to all doctors (ward based) including consultants. As we actively used the resources available in the hospital, it did not incur any costs to our knowledge.

The re-audit after 4 months demonstrated improved compliance of the involved variables. The application of appropriate thrombo-embolic prophylaxis and its dosage improved to 100% in both wards. Meanwhile prescription chart compliance for VTE risk assessment increased by 25% and 8% in female and male patient wards respectively (see table 1 and table 2). We believed it made significant cost savings by preventing venous thrombo-embolism. The cost of diagnosing and treating such conditions was largely prevented. Also the inpatient hospital stay was not extended in patients due to venous thrombo-embolic complications. This therefore helped in increasing availability of beds and indirectly reduced waiting list. Improved adherence to this NICE guidance indirectly affected other variables like Quality of health care, patient safety and low mortality and low morbidity rates.

Training be it hands on or by other means of communication improves outcome as it did in our hospital. Although compliance to VTE anticoagulation guidance was initially poor, results improved significantly following implementation of the educational program and the different training modes. We also believe that feedback and demonstration of individual ward performance after the baseline audit was paramount in improving adherence to the guidelines. We believe that to provide an environment of clinical excellence and to improve patient care and outcomes, robust clinical guidelines play a vital role. Therefore the success of this guidance comes with not only its implementation but also regular audit to check compliance and adherence to it. It also requires regular feedback, and training of individuals concerned. The message this audit imparts is proverbial: 'I hear and I forget. I see and I remember. I do and I understand'.