22 VTE prophylaxis guidelines in palliative care

<h3>Background</h3> Up to 15% of patients with cancer are thought to develop symptomatic VTEs. Further studies have shown up to 75% of patients are thought to develop sub-clinical VTEs due to their pro-thrombotic state. NICE guidelines (2010) emphasise a need for ‘balanced approach’ to VTE management in palliative patients. There is recognition that palliative patients being admitted, particularly into an acute hospital setting are often inappropriately prescribed VTE prophylaxis. <h3>Methods</h3> Collecting data involved review of clinical documentation and prescribing for all new admissions to the Countess of Brecknock Hospice over a one month period. Initial audit identified a lack of specific palliative care guidance on trust policy, as well as poor prescribing. Development of a VTE prophylaxis flow chart guideline involved discussion with the Hospital Thrombosis Committee and Hospice Palliative Care Consultant. This was then integrated into trust policy and SOP amendments. Re-audit of quantitative VTE prescribing data and qualitative prescriber confidence and knowledge was then conducted. <h3>Results</h3> Pre-intervention: 16 patients admitted to COBH (July 2021), 50% appropriately prescribed or not prescribed VTE prophylaxis as per guidance. Of those, 50% inappropriately prescribed, 63% had clinical indications for prophylaxis but not prescribed it, and 37% were given VTE prophylaxis without clinical indications. Post-intervention: 21 patients (December 2021). 100% appropriately prescribed prophylaxis with significant increases in documentation of initial risk assessment and ongoing reassessments every 48 hours. <h3>Conclusion</h3> Specific guidelines incorporated to the trust policy was demonstrated to be highly effective for improving VTE prophylaxis prescribing for patients admitted to the hospice. Maintaining the emphasis on trust wide education of VTE prophylaxis remains of high importance, but highlighting the specific needs of the Palliative Care patient cohort must be included. Specifically ensuring palliative care doctors are aware of the guidelines in order to promptly amend and re-review prescriptions from acute hospital settings.