title: Implementing NICE guidelines on risk assessment for venous thromboembolism: failure, success and controversy.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) prophylaxis guidelines were originally published by the National Institute of Clinical Excellence (NICE) in April 2007. Controversy eclipsed their release. Consequently, the VTE prophylaxis publication was reviewed and republished in January 2010. The NICE guidelines recommend that all patients are assessed for risk before pharmacological prophylaxis is offered and reassessed at 24 hours to check adverse reactions; and that prophylaxis is appropriate. This paper aims to look at their implementation.
  
  
  METHODS
  A prospective audit and re-audit in one orthopaedic department was completed to see how well the new guidelines were adhered to, find out first-hand what problems there were, and how they might be remedied.
  
  
  RESULTS
  Audit and re-audit highlighted that attaching an assessment tool to drug charts is plausible.
  
  
  CONCLUSIONS
  The study was limited to one centre and used a relatively weak research design.
  
  
  CONCLUSIONS
  As a process, the clinical impact of risk assessment for VTE is questionable as many patients will be high risk. Removing reassessment at 24 hours from the NICE guidance is recommended.
  
  
  CONCLUSIONS
  The authors put the NICE guideline into clinical practice, demonstrating how effectively it can work with their method, but also highlighting its flaws.
authors.affiliation: Department of Trauma and Orthopaedics, The Royal Berkshire Hospital, Reading, UK. dushanthavarajah@yahoo.com
authors.forename: Dushan
authors.initials: D
authors.lastname: Thavarajah
authors.forename: Martin
authors.initials: M
authors.lastname: Wetherill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000592:standards / Q000627:therapeutic use*; D018890:Chemoprevention / Q000592:standards; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D018570:Risk Assessment / Q000379:methods; D013222:State Medicine / Q000592:standards*; D006113:United Kingdom; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants