Background Venous thromboembolism (VTE), the formation of a blood clot in the veins, has a significant morbidity and mortality burden. Inpatient palliative patients often have increased risk factors (cancer, reduced mobility). NICE guidelines identify specific measures to reduce VTE risk. This closed loop audit aims to assess practice against NICE standards in an inpatient hospice setting with comparison before and after interventions.
Methods Standards (based on NICE guidelines) included admission VTE assessment, consultant review, daily VTE review and stopping VTE prophylaxis when a patient enters the dying phase. All adult inpatient admissions to the hospice over a one-month period were audited, initially in March 2021 and repeated in February 2022. Two authors collected and analysed the data from electronic patient records (EPR) and drug charts using excel. Interventions between audit cycles included the introduction of a consultant review and daily board round templates to the EPR and education sessions for junior doctors on the inpatient unit.
Results 35 patients were audited in March 2021, 15 in February 2022. All patients had an admission VTE assessment. There was significant improvement in consultant review of VTE assessment between cycles (9% to 100%), and a marked improvement in documented daily review of VTE assessment (0% to 80%). There remains need for improvement in stopping VTE prophylaxis when a patient enters the dying phase (57% to 66%). Limitations of this audit include the small number of participants, with confounding factors including time of hospice admission, patient age, phase of illness and performance status on admission.
Conclusion This closed loop audit of inpatient hospice VTE assessment identifies areas of good practice and impact of implementing EPR templates as prompts. We plan to add electronic prompts for daily VTE assessment, including review when a patient enters the dying phase to further improve practice.
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