Retrospective Clinical Audit of Adherence to a Protocol for Prophylaxis of Venous Thromboembolism in Surgical Patients

摘要

Background: Thromboprophylaxis after surgical procedures reduces the incidence of pulmonary embolism and deep vein thrombosis. In previous studies, adherence 'with recommended thromboprophylaxis guidelines has ranged from 13.3% to 94.0%.Objective: This clinical audit was conducted to evaluate the rate of adherence to the venous thromboembolism prophylactic protocol for surgical patients at the authors' institution.Methods: A chart review was conducted for surgical patients admitted from April 2005 to March 2006. Patients were included if they had undergone an elective surgical procedure, had been under general anesthesia for more than 45 min, had been admitted to hospital for more than 48 h, and were over 40 years old. Patients were excluded if they had been admitted for medical reasons, emergency surgery, or orthopedic surgery or if they had received anticoagulation before the surgery. Each patient's risk of venous thromboembolism was determined, and his or her thromboprophylaxis regimen was compared with the recommended regimen and assessed for adequacy.Results: Thromboprophylaxis was used for 82 of the 100 surgical patients whose records were reviewed. However, only 29% of the patients had received adequate therapy as defined by the prophylaxis protocol. The major reason for inadequacy of thromboprophylaxis was inappropriate stratification of the patient's risk of venous thromboembolism.Conclusion: Most surgical patients had received a thromboprophylactic regimen, but a large proportion of the patients received therapy that was suboptimal for their assessed level of risk. Provision of a checklist for assessing the risk of thrombosis and education of practitioners about risk stratification and the benefits of prophylaxis might improve adherence rates.