Deep vein thrombosis prophylaxis: Audit of practice in general surgical patients in a teaching hospital

Objective: To audit the prescription and implementation of deep vein thromb osis (DVT) prophylaxis in general surgical patients in a teaching hospital. Methods: All inpatients on three general surgical wards were audited for ad equacy of prescription and implementation prophylaxis (audit A). A repeat a udit 3 months later (audit B) closed the loop. The groups were compared usi ng the chi-square test. Results: In audit A 50 patients participated. Prophylaxis was correctly pre scribed in 36 (72%) and implemented in 30 (60%) patients. Eighteen patients at moderate or high risk (45%) received inadequate prophylaxis. Emergency admission, pre-operative stay and inadequate risk assignment were associate d with poor implementation of protocol. In audit B 51 patients participated . Prescription was appropriate in 45 (88%) and implementation in 40 (78%) p atients (p<0.05). Eleven patients at moderate or high risk received inadequ ate prophylaxis. Seven of 11 high-risk patients in audit A (64%) received a dequate prophylaxis, in contrast to all highrisk patients in audit B. The d ecision not to administer prophylaxis was deemed appropriate in 5 of 15 (30 %) in audit A compared with 6 of 10 (60%) in audit B. Conclusion: Increased awareness, adequate risk assessment, updating of prot ocols and consistent reminders to staff and patients may improve implementa tion of DVT prophylaxis.