Standard of surgical venous thrombo-prophylaxis in admitted patients

Abstract

Muhammad Salman Rafiq, Muhammad Imran Rafiq, Maria Rafiq, Seema Gul Salman, Sania Hafeez

A retrospective clinical audit of patients admitted to the surgical department over a one-year period from July 2014 to July 2015 was carried out. Data on risk assessment for venous thrombosis and prophylaxis was collected, including indications for enoxaparin and graduated stockings, their prescription and use. The correct dose and timing for enoxaparin, review of prophylaxis and counselling was also noted. Results: 157 patients, including 37 (23.6%) males and 120 (76.4%) females requiring thromboembolism prophylaxis were admitted to the emergency department during the audit period. Mean age was 50.97±12.74 years. Enoxaparin was indicated in all 157 patients, prescribed to 126 (80.3%) and administered in 120 (76.4%), respectively. Only 80 (51%) patients received the correct dosage and 85 (54.1%) patients received it at the required time. Graduated stockings were indicated in 110 (70.1%) patients, prescribed in 35(22.3%) cases and applied in 28 (17.8%), respectively. Review of prophylaxis was not performed in any of the patients at 72 hours. Counselling and information was provided to 31 (19.7%) patients. Thrombotic events occurred in 17 (10.8%) cases, of which 12 (7.6%) were lower limb deep venous thromboses and 5 (3.2%) were cases of pulmonary embolism. Conclusions: The audit fell short of the guidelines. Enoxaparin was prescribed and administered only in certain cases, both with the wrong timing and dosage. Stockings administration was rare and its counselling was lacking. Review of management was not performed in any case. The proposed recommendations should be implemented and assessed afterwards with a second audit cycle