7 November 2005

Risk to patient safety

Venous thromboembolism in patients, also known as deep vein thrombosis (DVT) due to its common manifestation in the deep veins of the legs, is being ignored in UK hospitals despite clear, evidence-based guidelines on the use of preventative treatments.

The findings, which are published in the November edition of the Journal of Royal Society of Medicine, follow a 24-month survey on medical inpatients in two major English teaching hospitals.

Deep vein thrombosis rose in prominence due to its association with long-haul flights, however, venous thromboembolism (VTE) is the most preventable cause of mortality in hospitalised medical inpatients. It is a potentially fatal condition with an annual incidence of 1-3 per 1000 per year and contributes to approximately 10% of all hospital deaths in the UK.

The study assessed 1062 patients of which 89% were found to have moderate and high risk of developing VTE. Of this category, 71% did not receive any form of prophylaxis. Of the 29% who did, prophylaxis was implemented correctly in only 4% of moderate and high-risk patients. Presentations about the recommended guidelines to fellow clinicians, after the first round of data collection, only increased use of prophylaxis to 31%.

The survey noted that the under utilisation of prophylaxis in medical inpatients was in marked contrast to the practice on many surgical wards.

Lead researcher, Dr Abdul Shlebak, said the situation was unsatisfactory.

“Clinicians and policymakers need to act on these findings if we are to reduce the incidence of VTE and prevent fatalities in hospitals,”

said Dr Shlebak.

Amongst the authors’ recommendations are: a DVT tick sheet attached to drug charts for all patients when admitted; greater understanding of DVT in medical and nursing education; and establishing dedicated antithrombotic teams charged with the task of raising awareness and auditing prophylaxis rates.

An accompanying editorial in the JRSM describes the current low level of thromboprophylaxis in UK hospitals as unacceptable and urges physicians to take greater responsibility by being aware of the evidence on VTE and act accordingly. ‘Venous thromboprophylaxis in UK medical inpatients’ by ST Rachid, MR Thursz, NA Razvi, R Voller, T Orchard and AA Shlebak is published in the November 2005 issue (volume 98) of the Journal of the Royal Society of Medicine.

Article [PDF 80k]
Editorial [PDF 44k]

JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.

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