647 VTE Prophylaxis Protocol Compliance Post Elective Lower Limb Arthroplasty
C Loh, B L Chen, A Semple, S Grant- Surgery
Abstract
Aim
Venous thromboembolism (VTE) is a common post-operative complication, and it is essential for surgical departments to ensure adequate prophylaxis is provided. A single centre DGH introduced a new proforma to be filled out at the time of operation. This audit aims to evaluate compliance with the proforma and its correlation to prophylactic prescription and postoperative VTE rates.
Method
A retrospective study was conducted for 524 patients undergoing elective lower limb arthroplasty between August 2020 and August 2022. Clinical notes were reviewed for of a) presence and completeness of proforma and b) clear documentation of prophylaxis. 30-day post-operative re-admission rates, associated complications, incidence of VTE, and deaths within 90 days of surgery were also reviewed.
Results
335 patients underwent an elective lower limb arthroplasty after the proforma was implemented in August 2021 of which 321 (95.8%) had the proforma in their clinical care forms. Of these, 56/321 (17.4%) forms were filled. All patients had documented VTE prophylaxis prescriptions and 438/524 (83.6%) were clearly described/'complete'. Of those incomplete, 74/86 (86%) were recorded after August 2021. There was 1 confirmed incidence of VTE within 30 days which occurred after proforma implementation. 9/18 surgeons (50%) practiced completing the proforma but 0/18 used it consistently.
Conclusions
There was poor compliance with the proforma but low incidence of VTE rates. Overall, the proforma did not affect VTE rates. In fact, there is the impression that reliance on the proforma worsened quality of documentation of VTE prescription required in operation notes. This suggests implementation of this proforma was negative.