Risk Assessment and Prophylaxis of Venous Thromboembolism in Patients of Medical Ward of Northwest General Hospital and Research Center, Peshawar, Pakistan: A Quality Improvement Project

Abstract

Background Venous thromboembolism (VTE) is a condition that occurs when a blood clot forms in veins. Hospitalization increases the risk of VTE so timely risk assessment and adequate prophylaxis for VTE should be done to prevent this potentially fatal complication. Local problem Data from developing countries regarding VTE prophylaxis is scarce. VTE is a neglected area of research in Pakistan. So this closed-loop clinical audit was conducted to evaluate the VTE risk assessment and prophylaxis practices and to analyze the importance of educational intervention in improving the standard of care. Patients and methods We adopted the National Institute for Health and Care Excellence (NICE) guidelines for VTE prophylaxis as an audit standard. We collected data on a specially designed proforma by prospectively reviewing the hospital notes of patients in the Medical Ward of Northwest General Hospital and Research Center, Peshawar, Pakistan. Phase A included 60 patients and after educational intervention, Phase B was conducted with 90 patients. Intervention The results of Phase A were presented in the Clinicopathological Conference (CPC) meetings of the hospital. Healthcare workers were educated regarding the risks of VTE and the importance of timely prophylaxis. Posters were also displayed in the ward for highlighting the importance of VTE prophylaxis. Results In Phase A, only 5% of patients were risk assessed for VTE and of those eligible for prophylaxis only 22.2% received the prescription. Phase B showed a significant adherence to standard practices. In Phase B, 100% of patients were risk assessed for VTE and 75% received the prophylaxis. Conclusion There was poor compliance with standard VTE risk assessment and prophylaxis prescribing practices. However, a simple and effective educational intervention markedly improved patient care in terms of VTE strengthening the impact of clinical audits in the improvement of care.

Keywords: clinical audit system; critical care and internal medicine; hospitalized patients; prevention; quality improvement and patient safety; venous thromboembolism (vte); vte prophylaxis.

Figure 1. Age-wise distribution of patients in Phase A (audit) and Phase B (re-audit)

Figure 2. Comparison of VTE risk assessment and prophylaxis prescription between Phase A and Phase B

VTE: venous thromboembolism