Title : Improving compliance with VTE prophylaxis prescribing in cardiology inpatients
Abstract:
Background: Venous Thromboembolism (VTE) prophylaxis is a national patient safety priority. Cardiology inpatients are at particular risk of developing VTE due to prolonged immobility post myocardial infarction, heart failure and cardiac procedures. A spot-check audit was done in 2023 at Birmingham Heartlands Hospital (BHH) which revealed inconsistent prescription practices, prompting a formal re-audit and quality improvement plan.
Aim: To assess compliance with national VTE prophylaxis guidelines in cardiology inpatients and identify areas for intervention.
Methods: All patients admitted to cardiology department at BHH between January 1 and February 28, 2025 were included in the audit. Data was collected using electronic records and clinic letters.
Results: A total of 510 patients were admitted to three cardiology wards during the audited period. 53% (n=266) of patients received appropriate VTE prophylaxis on Day 0 of admission or had a valid reason not to have it, most common reason being therapeutic anticoagulation indication. 28% (n=143) had delay in prescribing with 87 receiving the first dose on second day. 18.6% (n=95) were never prescribed VTE prophylaxis with no valid reason. However, none of these patients were readmitted with VTE within four weeks of discharge. Dosing accuracy was high (≈95%) once prophylaxis was prescribed.
Conclusions: There is significant underutilisation of VTE prophylaxis at the time of cardiology admissions. Despite accurate dosing, we know delay or omission in prescribing VTE prophylaxis is strongly linked to worse patient outcomes1. Resident doctor’s lack of familiarity with antithrombotic regimens is likely the main reasons for prescribing omissions at the time of admission. Structured prompts, improved documentation templates, and targeted education are planned as interventions. A follow-up re-audit is scheduled.
