Title : VTE prophylaxis in Trauma & Orthopaedic patients
Abstract:
Background: Venous ThromboEmbolism (VTE) is a common complication of trauma and orthopaedic (T&O) surgery. Pulmonary embolism and deep vein thrombosis in T&O patients have been estimated at 0.93% and 1.16% respectively, accounting for the considerable burden of disease looking at the annual cases averaging about 700,000 orthopaedic procedures in the UK. Fatal yet potentially preventable, VTE prevention remains priority worldwide. This project looked at the accuracy of VTE prophylaxis prescription in T&O patients according to local clinical guidance and aimed to improve its prescription and documentation.
Methods: Plan-Do-Study-Act (PDSA) quality improvement methodology was implied to identify ways to improve VTE prescription and documentation. Current policies, guidelines and practise were reviewed. Included in this standard is that all T&O patients should be under VTE prophylaxis unless specific reasons which should be clearly documented. Only orthopaedic patients in T&O wards were included, and information were gathered through assessing patient electronic systems and paper notes in the ward. Pre-intervention there were insufficient documentation, and one patient confirmed pulmonary embolism. A local guideline and risk assessment tool was created to provide guidance, identify patients, and serve as a self-audit tool affirming adherence to current guidelines. Additional interventions included education (departmental teaching delivery, posters in-hand, and email communication) for the multidisciplinary team in T&O department.
Results: Compliance rate improved to 99% in a 4-month period post-intervention. Only one patient was found not on VTE prophylaxis without appropriate documentation.
Discussion: VTE is a significant complication in T&O patients and has contributed to post-operative morbidity and mortality. Simple interventions have showed benefit in improvement of VTE prophylaxis prescribing and documentation. The engagement and awareness of the multidisciplinary team is the key to success in this intervention.
Audience Take Away:
- Understanding that venous thromboembolism (VTE) poses considerable risk to trauma and orthopaedic (T&O) patients, with significant implications for post-operative morbidity and mortality.
- The application of the Plan-Do-Study-Act (PDSA) cycle demonstrated a systematic approach to identifying and implementing improvements in clinical practice.
- Implementing local clinical guidelines and risk assessment tools vital in standardising VTE prophylaxis.
- Achieving a 99% compliance rate post-intervention demonstrates the effectiveness of rigorous assessments and precise documentation which can lead to enhanced patient safety and reduced post-operative complications.
