Orthopaedic Thromboprophylaxis Audit

Midland Regional Hospital Tullamore

May 2023
Why?
The National VTE survey (Irish Medical
Journal 2017)
- Survey of 40 acute hospitals.

-Need for a national risk assessment and thromboprophylaxis

policy in Ireland.

-Potential to prevent or reduce the morbidity and mortality

associated with hospital acquired thrombosis
Economic burden of VTE in
USA,Canada and Europe 2013
• Twenty-nine studies met eligibility criteria: United States , Canada ,
Australia , South America and Europe
-The estimated annual cost of VTE treatment is in excess
of $2 billion in the USA and Europe and $153 million in
Australia.
-Treating PE may cost up to five times more than treating DVT.
Aim
To assess the inpatient thromboprophylaxis practice over a two-
.month period from the 1st October- 30th November 2022

Methods
We assessed the thromboprophylaxis practice for the traumatic, lower
limb fractures at the orthopaedic department at Midland Regional
.Hospital Tullamore
Criteria
Weight
VTE assessment chart filling
VTE categorisation
Type of thromboprophylaxis
Antiembolic stocking use (AES)
*Dose to weight
Assessment against NICE Guidelines
Results
.A total of 96 patient’s drug charts were reviewed over a two- week period

Documentation of weight was done correctly over 11 patients

.patients had no any documentation of their weight 85-
Of those documented, 3 patients weighed < 50kg, 7 patients weighed-
.between 50-100kg and one patient weighed >100 kg

Dose of clexane to weight was correct for the above mentioned 11 patients-
(and was unknown for the remaining 86 patients)
Clexane was used as the thromboprophylaxis of choice in 86 patients.-
.(Rivaroxiban in 3, Apixaban in 2, Dabigatran in 1 patient)

.patients did not receive thromboprophylaxis 4-

AES use was documented for 31 patients. 65 had no documentation-

.done for AES

It is also not clear for the patients without VTE risk assessments-
.whether they had any contraindications to the use of AES
The VTE risk assessment chart was filled in for only 2 patients. The
.remaining 94 patients had no documentation of their VTE assessment

The two patients who had their VTE charts filled were classified as high
risk patients that required both AES and thromboprophylaxis
Discussion
From the above data it is clear that we need to improve-
.documentation and the VTE risk assessment need to be filled in

If there is contraindication to the use of AES this should be clearly-

stated in the AES section on the drug chart

Documentation of weight needs to be improved-

Action Plan

Incentivise documentation of VTE risk and weight (to the admitting-

and ward doctors)

Re audit after one month to check adherence-

Thank you