Iqbal Hassan
Surgery, Hull Royal Infirmary, Hull, GBR.
Cureus. 2024 Nov 7;16(11):e73186. doi: 10.7759/cureus.73186. eCollection 2024 Nov.
Background Venous thromboembolism (VTE) prophylaxis in hospitalized patients, particularly those undergoing abdominal surgery for cancer, is critical to reducing the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). Despite increased awareness, ensuring appropriate VTE prophylaxis post-discharge remains challenging. The National Institute for Health and Care Excellence (NICE) guidelines recommend prolonged prophylaxis in specific cases, yet compliance on discharge often falls short. Method A retrospective audit was conducted on 60 patients admitted for elective abdominal cancer surgery in a District General Hospital (DGH) from January to December 2023. This assessed compliance with VTE prophylaxis guidelines, both during admission and post-discharge. Following the first audit cycle, educational interventions for junior doctors, posters in relevant departments, and reminders in electronic patient records were implemented to enhance compliance. A second audit cycle was conducted over four months with 30 patients to evaluate the effectiveness of these interventions. Results Initial results showed 100% compliance with VTE assessments and inpatient prophylaxis but only 49.1% compliance with full 28-day post-discharge prophylaxis. Around 24.5% of patients received no further prophylaxis after discharge, while 20.8% exceeded the recommended duration. After the intervention, compliance with recommended VTE prophylaxis improved significantly, with 81.25% of patients completing the prescribed course and only 14.8% receiving inpatient-only prophylaxis. The number of patients exceeding 28 days of prophylaxis decreased from 20.8% to 3.7%. Overall, non-compliance fell from 50.9% to 18.5%. Conclusion Simple, targeted interventions, including education and reminders within electronic records, led to significant improvements in VTE prophylaxis compliance post-abdominal cancer surgery. Continued adherence to these strategies, alongside system-embedded reminders, is expected to sustain these improvements and further reduce VTE-related morbidity and mortality.
背景 住院患者，尤其是接受癌症腹部手术的患者，进行静脉血栓栓塞症（VTE）预防对于降低深静脉血栓形成（DVT）和肺栓塞（PE）的发生率至关重要。尽管人们的认识有所提高，但确保出院后进行适当的VTE预防仍然具有挑战性。英国国家卫生与临床优化研究所（NICE）指南建议在特定情况下延长预防时间，但出院时的依从性往往不足。方法 对2023年1月至12月在一家地区综合医院（DGH）接受择期腹部癌症手术的60例患者进行了回顾性审计。这评估了入院期间和出院后对VTE预防指南的依从性。在第一个审计周期之后，对初级医生进行了教育干预，在相关科室张贴了海报，并在电子病历中设置了提醒，以提高依从性。对30例患者进行了为期四个月的第二个审计周期，以评估这些干预措施的效果。结果 初步结果显示，VTE评估和住院期间预防的依从率为100%，但出院后28天全程预防的依从率仅为49.1%。约24.5%的患者出院后未接受进一步预防，而20.8%的患者超过了推荐疗程。干预后，推荐的VTE预防依从性显著提高，81.25%的患者完成了规定疗程，只有14.8%的患者仅接受了住院期间预防。超过28天预防的患者数量从20.8%降至3.7%。总体而言，不依从率从50.9%降至18.5%。结论 简单、有针对性的干预措施，包括电子记录中的教育和提醒，使腹部癌症手术后VTE预防的依从性有了显著提高。持续坚持这些策略，同时在系统中设置提醒，有望维持这些改善，并进一步降低VTE相关的发病率和死亡率。
