Introduction Venous Thromboembolism (VTE) is a source of significant preventable morbidity and mortality amongst hospital inpatients. NICE recommends considering VTE prophylaxis (VTEp) for patients receiving palliative care. This quality improvement project looked at the completion rate of VTEp assessment at Roxburghe House (RH), a Scottish Specialist Palliative Care Unit, where a VTEp pro forma was first introduced in 2018.
Aim To assess the completion rate of VTEp assessment and decision documentation amongst admissions to RH. To subsequently implement a modified VTEp assessment form to improve VTEp assessment and decision documentation according to NICE guidance.
Methods Admission documents for 36 consecutive patients to RH were reviewed from October to November 2020. Data including primary condition, admission medications, VTEp assessment, and VTEp decisions were recorded. A modified VTEp pro forma in an innovative flow chart format was introduced as the sole intervention. A further 27 consecutive patients‘ admission documents were subsequently reviewed.
Results 23/36(63.9%) of all admissions during the initial cycle had VTEp decision documented. 7/36(19.4%) were for VTEp and 13/36(36.1%) were not. Only 15/36(41.7%) had both VTEp assessment and decision documented. Amongst those with no VTEp prescribed nor decision documented, 9/36(25%) may benefit from VTEp on review. The VTEp decision documentation rate increased to 23/27(85.2%) after the intervention. 14/27(51.9%) were for VTEp, 8/27(29.6%) were not. 23/27(85.2%) had both VTEp assessment and decision documented. Amongst those with no VTEp prescribed nor decision documented, 3/27(11.1%) may benefit from VTEp on review.
Conclusion Two years after the implementation of VTEp assessment pro forma in RH in 2018, the VTEp assessment completion rate has decreased to pre-2018 level. The redesigned VTEp form has led to an increase in VTEp assessment and decision documentation rate in RH. Further work is required to assess the review of VTEp decisions on an ongoing basis during admission.
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