PROTOCOL VIOLATION IN DEEP-VEIN THROMBOSIS PROPHYLAXIS

This study aimed to determine how closely deep vein thrombosis (DVT) p rophylactic policies are adhered to in routine general surgical practi ce, to identify reasons for policy violations and to assess the effect s of policy modification. Eighty adult patients, sixty of whom had und ergone an operation, under the care of six general surgeons, each with their own written DVT protocol, were studied on one weekday. Thirty p atients (50%) did not receive DVT prophylaxis according to the policy of the relevant consultant. Most violations occurred for unacceptable reasons, mainly starting low-dose subcutaneous heparin or using thromb oembolic stockings postoperatively. However, 43% of protocol violation s occurred for acceptable clinical reasons. Following the initial stud y, a uniform departmental DVT prophylaxis policy was introduced. Nursi ng and medical staff were thoroughly appraised of the new policy. in a repeat study of 75 patients 1 year later, there were 15 protocol viol ations among 58 patients who had undergone an operation (27%). However , there were no violations for acceptable reasons. The number of unacc eptable protocol violations in the two studies was similar (24/60 and 17/56). The number of patients at moderate or high DVT risk who receiv ed no preoperative prophylaxis was the same in both studies (8/48 in b oth audits). DVT protocol violations are common in routine general sur gical practice. Policy modification and unification results in fewer v iolations, but made little impact on the level of thromboprophylactic care.