Venous thromboembolism prophylaxis audit in two Q ueensland hospitals

Background Venous thromboembolism ( VTE ) represents a major public health problem in A ustralia and worldwide, contributing to hundreds of thousands of deaths each year. Aim To assess adherence to recommended guidelines in a range of clinical settings. Methods Retrospective, observational study of 955 medical ( M ), surgical ( S ) and orthopaedic ( O ) patient charts of all M , S and O patients admitted during M arch 2011. Patients on warfarin were excluded from the analysis. Appropriate or inappropriate prophylaxis was assessed according to high, medium and low risk stratification. Patient risk stratification for VTE , suitability of prophylaxis given, adverse events and length of stay were recorded. Results Nine hundred and thirteen eligible patients were assessed, 54% male, mean age 57 ± 21 years. Regarding the 372  M patients, 235 (63%) were on appropriate prophylaxis, compared with 84% (273/326) S and 78% (168/215) O patients ( M to S , P < 0.0001; M to O , P = 0.0002; S to O , P = 0.113). High risk prevalence was 56% in M , 9% in S and 12% in O patients ( P < 0.0001). Nine confirmed or possible VTE events occurred (seven M , with five of these on inappropriate prophylaxis). All three bleeding events (one fatal) were in M patients, two of whom had appropriate prophylaxis. Average length of stay was 4.1 ± 5.0, 2.1 ± 3.3 and 2.1 ± 3.8 days ( P < 0.001) for M , S and O patients respectively. Conclusion Better adherence to prophylaxis guidelines is required, especially in M patients where the prevalence of high‐risk VTE is greater.