Specialty Trainee Registrar Palliative Medicine, Cardiff, Wales, United Kingdom.
North Tees Hospital & Alice House Hospice, Hartlepool, United Kingdom.
Thromb Res. 2023 Mar;223:95-101. doi: 10.1016/j.thromres.2023.01.021. Epub 2023 Jan 26.
The prevention of hospital associated thrombosis in palliative care remains controversial yet many countries recommend the documented risk assessment and where appropriate pharmacological prophylaxis of inpatients with advanced cancer.
To audit adherence to national guidelines which require hospitalised patients to be risk assessed and receive appropriate thromboprophylaxis.
A one day "flash-mob" audit across multiple clinical inpatient sites across the United Kingdom.
SETTING/PARTICIPANTS: Inpatients receiving palliative care within hospitals, hospices and specialist palliative care units across the United Kingdom.
Data were collected from 1125 patients (514 hospital and 611 hospice/specialist palliative care units). Appropriate thromboprophylaxis was observed in 90 % of hospital and 90 % hospice/specialist palliative care units. Documented risk assessment was only found in 79 % and 71 % of patient notes respectively. Pharmacological thromboprophylaxis was contraindicated in 88 % of hospice/specialist palliative care unit patients due to bleeding risk or receiving end-of-life care. Twenty-four percent of patients in hospital had contraindications due to receiving end of life care, bleeding risk and thrombocytopenia. Patients in hospice/specialist palliative care units were of poorer performance status prior to admission with a history of gradual deterioration. Hospitalised patients were more likely to have been admitted following an acute deterioration of previous good performance status.
Thromboprophylaxis guidelines were followed correctly for the majority of patients. There were considerable differences in the demographics of patients according to place of admission. Patients admitted to hospice/specialist palliative care units were sicker and had more contraindications to prophylaxis than those admitted to hospital. Thromboprophylaxis focused research data conducted in hospices is unlikely to be applicable to the care of palliative care patients admitted acutely to hospital.
在姑息治疗中预防医院相关性血栓仍然存在争议，但许多国家建议对晚期癌症住院患者进行有记录的风险评估，并在适当情况下进行药物预防。
审查对国家指南的依从性，该指南要求对住院患者进行风险评估并接受适当的血栓预防。
在英国多个临床住院地点进行为期一天的“快闪”审计。
地点/参与者：在英国的医院、临终关怀院和专科姑息治疗单位接受姑息治疗的住院患者。
从 1125 名患者（514 名医院患者和 611 名临终关怀/专科姑息治疗单位患者）中收集了数据。在 90%的医院和 90%的临终关怀/专科姑息治疗单位中观察到适当的血栓预防。只有 79%和 71%的患者记录中记录了有风险评估。由于出血风险或接受临终关怀，88%的临终关怀/专科姑息治疗单位患者的药物预防被认为是禁忌的。由于接受临终关怀、出血风险和血小板减少症，24%的医院患者也存在禁忌。入院前，临终关怀/专科姑息治疗单位的患者的表现状态更差，且有逐渐恶化的病史。与因之前表现状态良好而急性恶化而入院的患者相比，住院患者更有可能因急性恶化而入院。
大多数患者都正确遵循了血栓预防指南。根据入院地点，患者的人口统计学特征存在较大差异。与住院患者相比，入院临终关怀/专科姑息治疗单位的患者病情更严重，且预防血栓的禁忌更多。在临终关怀院进行的血栓预防重点研究数据不太可能适用于急性入院的姑息治疗患者的护理。
