PETER MCMANUS
Audit of VTE
Prophylaxis
Thromboprophylaxis: How are we doing?
Outline of Presentation
What is HAT?
Why is VTE prophylaxis Important?
How to Prevent Venous Thromboembolism
Audit results & Next steps
What is HAT?
NICE ”Hospital Acquired thrombosis (HAT) is all venous
thromboembolism (VTE) which occurs in hospital and within 90
days after hospital admission”
Common and partially
preventable problem
Why is Thromboprophylaxis important!
55-60% of VTEs occur PE as a result of DVT is VTE causes VTE has significant cost
during or following the leading cause of estimated 25,000 implications for the NHS
hospital admission preventable death in deaths annually
hospital
Clot Prevention Key Steps
STEP Risk assessment for all patients in hospital
1
STEP Re-assess when clinical change
2
STEP Provide appropriate VTE prophylaxis if at risk
3
STEP Verbal and written information on admission/discharge
4
Step 1: Risk Assessment
Risk assessment in all adults >16 admitted to hospital or having day procedures in
hospital
NICE: as soon as possible after admission or by the time of first consultant review
Risk assessment tool by national UK body (most common is DoH VTE RA Tool)
Balance the persons individual risk of VTE against their risk of bleeding hen
deciding whether to offer pharmacological prophylaxis
If Pharmacological VTE prophylaxis is appropriate, start within 14 hours of
admission
Step 2:
Reassessment NICE (2018): Medical, surgical and trauma patients should be reassessed for V
vs bleeding at the following stages:
of Risk
o Consultant Review
o Change in clinical state:
o Bleeding stopped/started
o Mobility
o Falls/ Head injury
o Procedure/ intervention
o COVID +ve
o ITU
Remember VTE risk assessment will likely need reviewed more than once during patients' hospital admission
Step 3:
Thromboprophylaxis
Types of VTE Prophylaxis
Mechanical
o Compression Stockings: OR 0.35 Pharmacological
o IPC Device: RR 0.18-0.68 vs no ppx Mechanical intervention such
& RR 0.24-0.91 vs AES VTE prevention using drugs as anti-embolic stocking
o Pharmacological: Enoxaparin 40mg such as LMWH (enoxaparin/ (AES) or Intermittent
dalteparin) or DOACs pneumatic compression (IPC
vs placebo (5.5% vs 14.9%)
Method
Audit 1 Education Audit 2
4-month observational study
2-month period 1-month period 1-month period
Medical and Surgical patients
Demographics: Risk Assessment: Type of Prophylaxis: Appropriateness:
o Age o Completion of risk o Mechanical vs o Was there prophylaxis
o Reason for admission assessment pharmacological o Suitability
o Weight o VTE risk o Dose o Complications
o Bleeding risk o DOAC use
Audit A
Total of 30 patients
Method of VTE prophylaxis
Weight Documentation in 21/30 (70%)
20%
23%
o 7 <50kg
o 16 50-100kg
o 2 >100kg
VTE risk assessment completed 9/30 (30%) 27%
30%
o High risk VTE + low risk bleeding: 20
No Prophylaxis/ anti-coagluation Enoxaparin 20mg Enoxaparin 40mg
o High risk VTE + high risk bleeding: 9 DOAC DOAC + LMWH
o Low risk VTE: 1
Audit B
Total of 20 patients
Type of VTE prophylaxis
Weight Documentation in 13/20 (65%) 10% 10%
o 4 <50kg
20%
o 8 50-100kg
o 1 >100kg
VTE risk assessment completed 8/20 (40%) 60%
o High risk VTE + low risk bleeding: 16 No Prophylaxis/ anti-coagluation Enoxaparin 20mg Enoxaparin 40mg
DOAC DOAC + LMWH
o High risk VTE + high risk bleeding: 4
o Low risk VTE: 0
Audit Results Comparison
VTE Prophylaxis
100
90
90 85
80 77 77
70
70 65
60
Percentage (%)
50
50
40
40
30
30
20
10
0
0
Weight Risk Assessment Pharmacological Mechanical Appropriateness
VTE Prophylaxis Results Audit A VTE Prophylaxis Results Audit B
Over the Years…
2019 2021 2022 Current Snapshot
VTE risk 34% 64% 22% 30-40%
assessment
completion
VTE prophylaxis 36% 48% 62% 77-90%
Discharge Information
For extended prophylaxis
Extended prophylaxis is certain situations such as post op
(Orthopedic operations)
Signs and symptoms of DVT and PE explained
Importance of VTE prophylaxis and continuing treatment for the
recommended duration
Importance of seeking help with DVT or PE and who to contact
Quality Improvement: Next Steps
Risk Assessment
- Further improvement required in documentation of VTE risk assessment in admission proforma
- Prescribing of VTE improving
Re-assess
- Frequent review of VTE prophylaxis:
o Falls
o AKI
o Interventions/Procedures
o Biochemically- Platelets etc.
o Weight
Patient Education
- Explain and consent, safety net
- Patient Information booklets
- Clear documentation in discharge letter on VTE prophylaxis post-discharge
Thank You
Peter McManus
