Risk assessment and prophylaxis of venous thromboembolism in surgical inpatients: improving adherence to national guidelines

A Practical Assessment of the Postoperative Management in Lung Cancer Surgery

Postoperative management after major and minor thoracic surgeries is crucial for patient recovery and can be challenging. Major thoracic surgeries, such as extensive pulmonary resections, especially in patients with poor health status, may require intensive surveillance, particularly during the first 24-72 h after surgery. Moreover, thanks to the demographic development and medical progress in perioperative medicine, more patients with comorbidities undergoing thoracic procedures require proper management in the postoperative period to improve prognosis and decrease hospital stay. Here, we summarize the main thoracic postoperative complications in order to clarify how to prevent them through a series of standardized procedures.

The effect of the transition to Electronic Patient Records on adherence to venous thromboembolism prophylaxis guidelines in general surgical patients

INTRODUCTION AND OBJECTIVES

Surgical patients are at risk of hospital-acquired venous thromboembolisms (VTEs), and preventative measures such as thromboembolism deterrent stockings (TEDs) and low molecular weight heparin (LMWH) are proven to be beneficial. The National Quality Requirement in the NHS Standard Contract 2017/19 in England mandates that 95% of inpatients undergo VTE risk assessments. As hospitals transition to Electronic Patient Records (EPR), it is important to observe the impact on vital safety indicators such as VTE risk. The aim of this study is to observe the effect of implementing EPR in a tertiary centre on adherence to national guidelines, including VTE assessment rates and prophylaxis administration in surgical patients.

MATERIALS AND METHODS

Using consecutive sampling, all acute surgical admissions at the hospital from 26/02/2018 to 18/03/2018 (n=154) pre-EPR and 31/10/2018 to 25/11/2018 (n=151) post-EPR were observed for VTE risk assessment, 24-h re-assessment, prophylaxis prescriptions, administration, and patient compliance. Data was compared using a two-tailed Z-test.

RESULTS

Pre-EPR, 96% of patients had completed VTE assessments, which increased after EPR implementation to 97% (p=0.39). LWMH prescription rates decreased from 82% to 77% following EPR (p=0.14). Moreover, TED prescriptions decreased from 84% to 64% post-EPR (p<0.01). Administration rates of prophylaxis generally improved post-EPR. The 24-h re-assessment rate decreased from 62% to 54% of patients (p=0.08).

CONCLUSION

The study demonstrated that EPR is non-inferior to paper records. Transitioning to an EPR system did not interfere with the completion of VTE risk assessments, hence did not negatively impact the ability to achieve national targets.

Prevention of venous thromboembolism in postoperative abdominal patients: a best practice implementation project

OBJECTIVES

This project's aim was to ensure that venous thromboembolism assessment was performed accurately, and that adequate prophylaxis was followed-up, resulting in a decrease in the incidence of venous thromboembolism postoperatively and enhancing recovery after surgery.

INTRODUCTION

Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients. Evidence suggests that the majority of hospital patients are at risk for VTE, but the prophylaxis recommended for their risk factors are not adequately utilized. Venous thromboembolism prevention is primarily based on an adequate risk stratification.

METHODS

A baseline audit on VTE prevention utilizing the Joanna Briggs Institute Practical Application of Clinical Evidence System program was undertaken and involved 21 nurses and 30 patients. An intervention including VTE education, clinical practice and prophylaxis was conducted, following which a post-implementation re-audit was undertaken.

RESULTS

The baseline audit results showed that four audit criteria results were found to under 30%, which indicated poor compliance with the current evidence. After implementing the strategies, including education, VTE video, etc., there was a huge improvement, with most of the audit criteria achieving 100% compliance.

CONCLUSIONS

Overall the project achieved a significant improvement in evidence-based practice in the prevention of VTE, implemented in two wards. Sustaining best practice should be planned for the future.