Ensuring timely thromboprophylaxis on a Medical Assessment Unit

The Department of Health has defined hospital acquired venous thromboembolism (VTE) as any VTE event occurring within 90 days of hospital admission or surgery. (1) Hospital acquired thrombosis (HAT) is common during and after hospital admission and is considered a major patient safety issue. Current NICE guideline (CG 92) 2010, recommends that medical patients assessed at risk of VTE should have pharmacological prophylaxis commenced as soon as possible after risk assessment has been completed and continued until the patient is no longer at increased risk of VTE. (2) This quality improvement project was carried out in the medical assessment unit in Derriford Hospital, Plymouth. We aimed to increase appropriate VTE pharmacological prophylaxis to 100% prescribed in 6 hours by the end of May 2016 using the Plan-Do-Study-Act (PDSA) methodology. The primary outcome measure was whether or not enoxaparin was given within 6 hours of admission. Analysis showed that a major contributing factor to the prolonged time interval was lack of awareness of the Trust VTE guidelines which had recently been updated in accordance with NICE recommendations. Baseline measurement demonstrated that 29% of patients had first dose of enoxaparin within the 6-hour target, with a mean delay of 12 hours 22 minutes. With implementation of an education programme and development of a local VTE prevention care pathway to raise awareness of the new guidelines, a significant improvement was achieved with 71% of patients meeting the 6-hour target in PDSA cycle 1 and 83% of patients in PDSA cycle 2. The average time interval also reduced to 5 hours 52 minutes in PDSA cycle 1 and 5 hours 7 minutes in PDSA cycle 2. In conclusion, through utilization of simple change methodology, enoxaparin prescribing practice significantly improved. Potentially this may reduce morbidity (and mortality) associated with HAT together with cost implications of its management.