Thromboprophylaxis Audit at MRHT orthopaedic

department

Prepared By M.Alfahal Ortho SHO

Supervised By Prof.Sheehan/Oliver/Waleed
:Aim •
To assess the inpatient thromoboprophylaxis practice over a two month
.period from the 1st/ October- 30/November/2022

:Method
We assessed the thromboprophylaxis practice for the traumatic non
spinal lower limb fractures at the orthopaedic department at midland
.regional hospital tullamore
:Criteria
Weight
VTE assessment chart filling
VTE categorization
Type of thromboprophylaxis
Use of AES
*Dose to weight
: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 while the

remaining 85 patients have no any documentation for their weight. Of those
documented 3 patients weighted < 50kg, 7 patients weighted between 50-
.100kg and one patient weighted >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 patient.
Rivaroxiban in 3 patients. Apixaban in 2 patients. Dapigatran in 1
.patient. 4 patients did not receive thromboprophylaxis

AES use was documented for 31 patients. 65 Patients have no

.documentation done for the AES

It is also not clear wether any patient from the 65 patients for whom
the AES was not documented has any contraindication for the use of
.AES
VTE chart was filled for only 2 patients. The remaining 94 patients have
.no any documentation for their VTE assessment

The two patients who have their VTE charts filled were classified as
.high risk patients that require both AES and thromboprophylaxis
:Conclusion
From the above data it is clear that we need to improve documentation
.and VTE risk assessment need to be done more aggressively

AES are non harmful method that can be widely used to reduce the risk
.of VTE

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

stated in the AES section on the drug chart
Documentaion of weight is not important only for dose calculation, it is
important also for fluid balance and for decision if the patient needs
a post-operative nutritional support especially if the patient is passing
.through a long process of recovery from major surgery or trauma

:Plan
Re auditing after one month to check the adherence to documentation

Teaching of the admitting doctors regarding the importance of

.documentation and clearing of any mis-understanding
Thank you