Venous thromboembolism. Prophylaxis on a Saturday morning in a district hospital.
BACKGROUND
Implementation of guidelines to prevent venous thromboembolism (VTE) is essential to help guide junior medical staff but adherence to such protocols is insufficient. This study aims to audit the use of VTE prophylaxis (Tinzaparin 3500 units and/or thromboembolic deterrent stockings (TED) in general surgical inpatients in a district hospital on a random day at the beginning (Group A) and at the end of the junior house officer's 6 monthly term (Group B).


METHODS
Patients were analyzed within the subgroups elective and emergency admissions and assessed regarding the appropriate prescription of tinzaparin and TED-stockings. The presence of a significant time lag between patients arriving on the ward and VTE-prophylaxis being prescribed was documented.


RESULTS
Tinzaparin was appropriately prescribed or not prescribed if contraindicated in 86% of elective admissions in Group A (versus 91% in Group B) and in 58% of emergency admissions in Group A (versus 85% in Group B). The subcutaneous injection of tinzaparin was commenced on the day of admission in 67% in Group A and in 75% of patients in Group B. CONCLUSIONS. Despite the institution of local guidelines adherence to such recommendations appears to be sub-optimal even at the end of the junior house officer's 6 monthly term when one would expect a higher vigilance.
Fassiadis
N
N
Department of General Surgery, Bromley Hospital, UK. nfassiadis@doctors.org.uk
Stavrianakis
C
C
Moghraby
O S
OS
Gandhi
P
P
Smedley
F H
FH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011897:Random Allocation; D013923:Thromboembolism / Q000517:prevention & control*; D013997:Time Factors; D000078222:Tinzaparin; D014689:Venous Insufficiency / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin