Audit of thromboprophylaxis prescribing in medical patients with renal impairment
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Saudi Digital Library
Abstract
1- Abstract:
Background: Venous thromboembolism (VTE) is a preventable disease that involves hospitalised patients. The NHS Greater Glasgow and Clyde (GGC) guidelines for thromboprophylaxis recommend using low-molecular-weight heparins (LMWHs) to reduce VTE incidence in medical patients. Dose adjustment should be required in patients with renal impairment because of the risk of bleeding due to the accumulation of LMWHs.
Aim: The purpose of this audit is to assess compliance with the VTE prophylaxis recommendations in the NHS GGC guidelines for medical patients with renal impairment (CrCl <30ml/min).
Methodology: A retrospective observation audit was undertaken for adult medical patients with creatinine clearance (CrCl) <30ml/min upon admission between November 2020 and February 2021 to medical receiving wards and medicine department for elderly wards at GRI. The data was collected from the Clinical Portal by searching clinical assessment notes, VTE risk assessment tools, Kardex, and laboratory data. The CrCl rate was calculated according to the Cockcroft–Gault equation.
Results: Out of the 50 patients included in this audit, 56% (n=22) received an inappropriate thromboprophylaxis dose. Furthermore, 82% of the patients (n=41) had not completed a VTE risk assessment tool upon admission. In monitoring patients’ CrCl on day 5, 44% of the patients (n=22/50) presented a change in their CrCl. Moreover, 50% (n=11/22) of those patients underwent an appropriate dose adjustment in line with their CrCl on day 5. The audit results showed that no patients (n=0/30) had their anti-factor Xa levels checked after the 10th dose.
Conclusion: This audit has shown a gap between the NHS GGC guideline recommendations and clinical practice during thromboprophylaxis prescription for medical patients with CrCl <30ml/min. Further audit is required to better understand the healthcare providers’ reasoning behind non-compliance with the NHS GGC guideline recommendations for thromboprophylaxis.