An integrated assessment proforma and education package improves thromboembolic prophylaxis prescription in urological patients
PURPOSE: The National Institute of Clinical Excellence (NICE) has published evidence-based guidance on assessing and reducing the risk of venous thromboembolism (VTE). Despite this, practice and compliance are variable. We report a complete audit cycle, which quantified compliance and then implemented measures to improve compliance toNICE guidelines in Wycombe Hospital (district general hospital, Oxfordshire) Urology Department.
METHODS: The case-notes of 48 consecutively discharged inpatients were reviewed and 22 data items extracted. These included evidence of a VTE risk assessment having been completed, prescription of compression stockings and prescription of low molecular weight heparin. From these, the level of compliance with NICE guidelines was determined.
RESULTS: Our initial audit revealed that only 10% of 48 patients had been both risk assessed and prescribed appropriate prophylaxis during their admission. Potential reasons for non-compliance were identified and targeted changes implemented. The three interventions were 1) a urology emergency admission clerking proforma with integrated thromboembolic risk assessment (UAP), 2) formal VTE education for doctors at monthly clinical governance meetings and 3) incorporation of thromboembolic prophylaxis training into junior doctor induction. Six months later, the casenotes of 49 patients were reviewed using identical methodology. The rate of full compliance had risen from 10% to 65%.
CONCLUSION: An integrated UAP form and education package improves VTE risk assessment and thromboembolic prophylaxis prescription in urological patients. The UAP may also be a useful tool for implementing future improvements to urological practice.
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