Abstract: Prescribing Extended VTE prophylaxis (EVTE) for 28days in abdominal cancer surgery is a NICE guideline NG89. In Europe, there are 544,000 VTE-related deaths every year (55-60% during or following hospitalisation), 25 000 in the UK. In the UK average annual costs for VTE treatment, hospital bed days, sanctions and litigation for 2016/17 was £938,357 per CCG. 71% of patients assessed to be at medium or high risk of developing VTE did not receive any form of mechanical or pharmacological VTE prophylaxis.
Objectives: To improve extended VTE prophylaxis prescription in the General surgery ward for patients who have undergone abdominal cancer surgery. At the time of the first audit cycle compliance was 79%. The aim was to achieve 100% compliance upon implementing our initiatives.
Methods: This involved both qualitative and quantitative methods. We utilised a process map and a driver diagram to achieve our goals. Audit cycle one was completed in December 2018. Cycle 2 was completed in May 2019 after introducing our initiatives. We reviewed Lower GI mortality and morbidity data. We compared this data with Electronic discharge notes for all cancer surgery within this period. This included date of surgery and date of discharge and Anticoagulation on discharge.
Results: NICE Guidelines are to prescribe 28 days of VTE prophylaxis postoperatively for patients discharged post lower GI cancer surgery. Audit cycle 1 in December 2018 looked at 53 patients. 11 of the 53 were non complaint = 21%. After our Quality initiatives the audit cycle 2 in May 2019 looked at 118 patients. Only 1 was non-complaint = 1%.
Conclusions: The project was able to improve compliance in prescribing to reduce the risk of VTE in post abdominal cancer surgery from 79% to 99% within 5 months. This was achieved by following the well tested pathway to successful teams. Leadership communicated clear measurable goals to a dedicated team and most importantly by keeping the project simple and not reinventing the wheel. The initiatives we implemented can be applied to improve services in other departments and other hospitals.
Keywords: EVTE: Extended Venous Thromboembolism, PE: Pulmonary Embolism DVT: Deep Venous Thrombosis, LMWH: Low Molecular Weight Heparin, EDN: Electronic Discharge Notification, QIP: Quality Improvement Project, CCG: Clinical Commissioning Group.
Title: How improved compliance was achieved in prescribing to reduce the risk of Venous thromboembolism (VTE) in post abdominal cancer surgery: A quality improvement project
Author: Mohammad IMTIAZ, Zwelibanzi Moyo, Kwaku Baryeh
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
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