Pathophysiology of venous thromboembolism

Thromboprophylaxis awareness among hospital staff

AIM

Following the introduction of thromboprophylaxis risk assessment tools at Southampton University Hospitals Trust in April 2008, this audit aimed to assess the level of understanding for correct thromboprophylaxis use for patients among hospital staff within the trust.

METHODOLOGY

50 members of staff, including doctors, nurses and pharmacists, chosen at random, were surveyed using a questionnaire. They were asked whether they thought venous thromboembolism was a problem among hospital patients; their awareness of the current prevention tools in the trust; whether they complete the assessment labels in patients' admission notes; and whether they have seen incorrect use of thromboprophylaxis and had they taken appropriate action to correct the errors.

OUTCOMES/RESULTS

The authors found that while the general level of awareness for thromboprophylaxis is good within the organization, compliance with the Trust guidelines was inadequate at 32%, resulting in high levels of inappropriate thromboprophylaxis use which is poorly recognized by staff. In particular, there is a lack of participation from nursing staff owing to a lack of motivation and confidence. Only half of the doctors surveyed completed thromboprophylaxis assessment labels on patients' admission notes; all were junior doctors. Pharmacists were generally better at recognizing and correcting errors in thromboprophylaxis prescription compared with doctors.

CONCLUSIONS

It is clear from this audit that staff knowledge and attitudes to thromboprophylaxis must be improved further by reinforcing educational programmes for both medical and non-medical health professionals. A thromboprophylaxis lead should be appointed for each professional group to ensure efficient monitoring. Teaching should be extended to patients to ensure individualized care for all.

Venous thromboprophylaxis in acutely ill patients: nursing role

Venous thromboembolism (VTE) is a serious medical problem and is one of the most important preventable causes of mortality and morbidity in hospitalized patients. This article reviews the prevention of VTE with thromboprophylaxis in acutely ill general medical patients. We review recent studies which show that general medical patients are at moderate risk of VTE and that low-molecular-weight heparin reduces this risk. Nurses have a key role to play in changing clinical practice by increasing awareness of the risk of VTE in medical patients, helping in the process of risk assessment and ensuring appropriate prophylaxis.