AB212. SOH21AS262. Venous thromboembolism prophylaxis in orthopaedic surgical admissions at Beaumont Hospital

Background: Orthopaedic surgery patients have long been recognized to be at increased risk of venous thromboembolism (VTE). VTE is a significant cause of mortality, long-term disability and chronic ill-health. VTE is considered internationally to be a silent killer with fewer than 1 in 10 fatal cases of pulmonary embolism diagnosed before death. In the UK, the cost of treating non-fatal symptomatic VTE and associated long-term disability is around £640 million per year.

Methods: Data was collected from 50 patients who were admitted under the orthopaedic team over 1 month using a pre-designed proforma. Information on TEDS, anticoagulants and doses prescribed was acquired from the drug MPAR. Patient weight could be found in the drug MPAR or nursing notes and eGFR was obtained from the lab results system.

Results: Out of 50 patients, 11 were on anticoagulants prior to admission. Enoxaparin was not charted on day 0 of admission in 11 cases. Four patients were not charted for enoxaparin—all 4 were charted for other anticoagulants. Ten of 46 patients were charted an inappropriate dose of enoxaparin. Five of these doses were too high for reduced eGFR and 5 were too low for the patient’s weight. Twenty-four of the 43 patients charted for TEDS were wearing them. Of the 19 not wearing TEDS, 1 had a reason documented.

Conclusions: VTE poses a significant risk to orthopaedic surgery admissions. This data suggests VTE prophylaxis for orthopaedic admissions at Beaumont hospital have potential for improvement. Our planned intervention aims to address this in VTE prophylaxis standards. This will be reaudited 3 months post intervention.

Keywords: Venous thromboembolism prophylaxis (VTE prophylaxis); TEDS; enoxaparin; orthopaedic surgery