Introduction NICE recommend considering VTE prophylaxis for palliative care patients with potentially reversible acute pathology, taking into account potential risks/benefits and the views of patients and families. In Roxburghe House Specialist Palliative Care Unit (RH), NHS Grampian, there is no formal decision-making process around VTE prophylaxis.
Aim To assess the current level of documentation of decision-making regarding VTE prophylaxis in patients admitted to RH. To subsequently introduce a VTE assessment proforma as part of the admission pack to prompt decision-making and documentation of VTE prophylaxis decisions.
Methods The notes of 19 inpatients in RH were reviewed. The following data was recorded: diagnosis, VTE prophylaxis on admission/at time of data collection, documentation of decision as well as potential risks/benefits from VTE prophylaxis.
Following this, a VTE assessment proforma was introduced in the admission documentation for RH. The notes of patients admitted following were subsequently analysed.
Results Initially, only 8 patients (42%) admitted to RH had a documented decision regarding VTE prophylaxis. 10 patients (53%) were receiving prophylactic or treatment dose Dalteparin. Of the remaining 9 patients (47%), it was felt that 6 would not benefit from VTE prophylaxis (4 had active bleeding, 2 had cerebral tumours), and that 3 may benefit.
Following the implementation of the VTE prophylaxis proforma, Preliminary results show that 11 patients (100%) had a documented decision in the medical notes regarding VTE prophylaxis. 2 patients (18%) were started on prophylaxis and in 1 patient it was continued.
Conclusion The documentation of decision making regarding VTE prophylaxis in RH was initially poor. Following implementation of the assessment tool there has been improvement in documenting and discussion around VTE prophylaxis.
Data collection is still ongoing. The next step will be to assess if VTE prophylaxis prescriptions are reviewed, e.g. monitoring platelets, reviewing the duration and appropriateness of treatment.
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