Adherence to NICE guidelines for Venous Thromboembolism (VTE) Prophylaxis in Surgical Patients – Examining the Impact of Electronic Prescribing and Medicines Administration (EPMA)

Abstract

Background: Venous thromboembolism (VTE) poses a significant healthcare burden, leading to mortality and long-term complications. Despite guidelines, VTE prophylaxis rates remain low. In surgical settings, VTE prophylaxis is effective but often administered inappropriately. The National Institute of Health and Care Excellence (NICE) guidelines provide a comprehensive approach to VTE risk assessment and prophylaxis, emphasizing patient safety. Aims: This audit at Lister Hospital- East and North Herts NHS Trust in the United Kingdom aims to assess compliance with NICE guidelines for VTE prophylaxis in surgical patients, assess the impact of the newly introduced Electronic Prescribing and Medicines Administration (ePMA) system, to identify areas for improvement in patient care and policy development. Methods: This retrospective observational study analysed Lister Hospital's medical records to assess compliance with NICE guidelines for VTE prophylaxis in 88 surgical ward patients between Dec 2021 and Mar 2022. Data was collected from medical charts using convenience sampling, allowing for nonrandomized selection. Researchers assessed protocol adherence using six steps: 1st VTE assessment checklist completion, 1st Dalteparin prescription, 1st Dalteparin administration, 2nd VTE assessment, TEDS prescription, and TEDS administration. Results: This audit revealed variability in protocol adherence among patients, with concerns such as incomplete checklists n=49 (55.7%), low stocking prescription adherence n=36 (40.9%), and rare second VTE assessments n=7 (8%). Younger patients showed better protocol completion, and gender differences were noted, with females being more compliant with TEDS usage. Post-ePMA implementation, there were significant decreases in adherence for 1st VTE Checklist (p = 0.00001), second VTE assessments (p = 0.05), and TEDS prescription (p = 0.0001) compared to the pre-ePMA group. Conclusion: Adherence to NICE guidelines is currently suboptimal and interventions are required to optimise the adherence to guidelines and improve the effectiveness of ePMA. Improving understanding of the importance of adherence to the NICE guidelines on VTE prophylaxis, addressing protocol completion gaps, and enhancing education of ePMA system usage are key strategies for optimizing the ePMA model's effectiveness in the future. Medical practitioners in the surgical sections should undertake educational sessions via posters or presentations outlining the NICE guidelines. Appropriate and comprehensive training sessions tailored towards evidenced shortcomings in completing the protocol and ePMA usage is recommended, with further bi-annual mandatory training sessions to ensure and reinforce staff competencies. Categories: General Surgery, Healthcare Technology, Therapeutics Keywords: electronic prescribing and medicines administration (epma), pulmonary embolism, deep vein thrombosis, surgical patients, vte prophylaxis protocol