Deep vein thrombosis in Sri Lankans - time to take notice

Sheriffdeen, AH; Wijeyaratne, Mandika

doi:10.4038/cmj.v46i1.6514

Cited by 3 publications

(3 citation statements)

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“…The rate of postpartum haemorrhage appeared to be lower than what would be expected for LMIC according to international literature,34 leading us to double check this statistic in the hospital registers and found to be correct (Table 1). The low prevalence of deep vein thrombosis and pulmonary embolism may be due to the fact that these events are less frequent in the Asian population compared with others or to under-reporting 35 36…”

Section: Discussionmentioning

confidence: 95%

Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care

et al. 2019

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ObjectivesThis study was aimed at piloting a prospective individual patient database on hospital deliveries in Colombo, Sri Lanka, and at exploring its use for developing recommendations for improving quality of care (QoC).DesignObservational study.SettingDe Soysa Maternity Hospital, the largest referral hospital for maternity care in Sri Lanka.Data collection and analysisFrom July 2015 to June 2017, 150 variables were collected for each delivery using a standardised form and entered into a database. Data were analysed every 8 months, and the results made available to local staff. Outcomes of the study included: technical problems; data completeness; data accuracy; key database findings; and use of data.Results7504 deliveries were recorded. No technical problem was reported. Data completeness exceeded that of other existing hospital recording systems. Less than 1% data were missing for maternal variables and less than 3% for newborn variables. Mistakes in data collection and entry occurred in 0.01% and 0.09% of maternal and newborn data, respectively. Key QoC indicators identified in comparison with international standards were: relatively low maternal mortality (0.053%); relatively high maternal near-miss cases (3.4%); high rate of induction of labour (24.6%), caesarean section (30.0%) and episiotomy (56.1%); relatively high rate of preterm births (9.4%); low birthweight rate (16.5%); stillbirth (0.97%); and of total deaths in newborn (1.98%). Based on key indicators identified, a list of recommendations was developed, including the use checklists to standardise case management, training, clinical audits and more information for patients. A list of lessons learnt with the implementation of the data collection system was also drawn.ConclusionsThe study shows that the implemented system of data collection can produce a large quantity of reliable information. Most importantly, this experience provides an example on how database findings can be used for discussing hospital practices, identifying gaps and to agree on recommendations for improving QoC.

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Section: Discussionmentioning

confidence: 95%

Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care

et al. 2019

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“…Clinical guidelines and protocols have been written by the NICE to identify this risk and administer appropriate prophylaxis 2 . A.H Sheriffdeen highlighted the importance for VTE prophylaxis in Sri Lanka in 1984 and further re-iterated it in 2001 3,4 . 10 years later the National Health Service in Sri Lanka is still short of (freely accessible) guidelines on VTE prophylaxis.…”

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confidence: 99%

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

Seneviratne

Hemachandra

Abayadeera

2012

Sri Lankan J Anaesthesiol

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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.

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“…They are also known to be a major complication of cancer and are one of the leading causes of mortality from cancer. Though the actual incidence of DVT in Sri Lankan surgical populations has not been reported it is a common belief that there is a reasonable incidence 3,4 . The problem often is that the risk status is not assessed based on patient and surgical factors and appropriate preventive measures are not adopted.…”

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confidence: 99%