Audit of venous thromboembolism prophylaxis administered to general surgical patients undergoing elective and emergency operations at National Hospital, Sri Lanka

Abstract

Venous thromboembolism (VTE) is a significant global cause for morbidity and mortality of surgical patients. Clinical guidelines written by the National Institute of Clinical Excellence (NICE) in Great Britain is available to manage this problem. The Sri Lanka Health Service currently has no such guidelines. We conducted a retrospective audit of current practice of VTE prophylaxis in general surgical patients having operations at the National Hospital of Sri Lanka (NHSL). Ethical approval was obtained. Clinical records were perused to audit risk assessment and management by clinical teams involved. A data form addressing NICE guidelines was used and statistically analysed. Of 244 cases listed in the theatre register 154 case notes were located. We identified that clinical staff were deficient in obtaining information required to classify patient risk of VTE. Only 13% of cases had a Body Mass Index calculated. Sub optimal records were evident in the surgical, anaesthetic and nursing notes. Majority of cases had one or more risk factors for VTE. Most patients underwent elective surgery under general anaesthesia. 71.4% of patients had an indication for mechanical, pharmacological or both methods for VTE prophylaxis. None of the patients requiring only mechanical or only pharmacological prophylaxis received any. Only 5.9% of patients were correctly administered both forms of prophylaxis when required. Administration of mechanical prophylaxis was not documented in a single case. We suggest changes at an institutional/ individual level. These should aim to improve proper note binding, clinical record keeping, availability of guidelines/ protocols and a multidisciplinary approach to risk assessment. Hospitals should ensure a minimum standard availability of mechanical prophylaxis. Anaesthetists should cover VTE risk during pre-operative assessment. Mechanical prophylaxis commenced in theatre should be documented in the anaesthetic chart. Post-operative visit should include a risk assessment for ongoing risk of VTE. Measures should be taken to re-audit clinical practice according to set guidelines in future.

Audit of perioperative management of patients with fracture neck of femur

“…According to an audit done in general surgical patients, 98% of moderate to high risk patients did not receive thromboprophylaxis. 10…”