Administration of heparin and antibiotic prophylaxis

A Simple Way to Improve DVT Protocol Compliance

Objective:

To assess the impact on deep vein thrombosis (DVT) protocol violations of the introduction of a label attached to the patient's drug chart, which specifically allows low-dose subcutaneous heparin or thromboembolic deterrent stockings (TEDS) to be prescribed as appropriate.

Design:

An audit study.

Setting:

Department of General Surgery of a District General Hospital in the United Kingdom.

Method:

All adult general surgical inpatients on a Weekday were studied. Staff were not forewarned of the studies. Patient details and risk factors for DVT were noted. Details of administered DVT prophylaxis were recorded. In total four separate studies were undertaken, namely: with original protocols (I), with refined protocol 1 and 3 years later (II, III) and finally after introduction of the label (IV).

Results:

Protocol violations were defined as being ‘acceptable’ or ‘unacceptable’. Raising awareness between studies I and II reduced acceptable violations to zero. There was no statistically significant reduction in unacceptable violations (24 in 80 patients, 1; 17 in 75, II; 13 in 60, III). In study IV, following introduction of the label, there were only 6 violations in 51 patients ( p<0.02).

Conclusion:

Combining increased awareness with the attachment of a label to the drug chart reduced unacceptable violations by 63%.

Effective administration of heparin and antibiotic prophylaxis

A prospective audit was performed to determine whether new departmental procedures had improved the administration of heparin and antibiotic prophylaxis in patients undergoing major surgery who were at risk of deep vein thrombosis, pulmonary embolism and postoperative wound infection. The results are compared with a previous retrospective audit of the same 'at-risk' groups. A significant improvement in prophylaxis administration is demonstrated.