Improving adherence to venous thromboembolism prophylaxis guidelines in surgical inpatients: a closed-loop clinical audit in a resource-limited setting.

BACKGROUND

Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality among hospitalized surgical patients. Although evidence-based guidelines exist, adherence remains suboptimal, particularly in low- and middle-income countries. This audit assessed adherence to National Institute for Health and Care Excellence (NICE) guidelines for VTE prophylaxis among surgical inpatients and evaluated the impact of a targeted educational intervention.

MATERIALS &

METHODS

A prospective clinical audit was conducted at a tertiary care hospital. Adult surgical inpatients were assessed over two audit cycles of 100 patients each. The first cycle evaluated baseline compliance with five NICE NG89 standards: VTE risk assessment, bleeding risk assessment, appropriate thromboprophylaxis prescription, reassessment during admission, and patient information documentation. Following a targeted educational intervention and the introduction of structured documentation tools, a re-audit was performed. Data were analyzed descriptively and presented as proportions.

RESULTS

Baseline adherence was poor across all domains. No patients had documented VTE or bleeding risk assessments, and appropriate thromboprophylaxis was prescribed in only 3.1% of cases. Following the intervention, documentation of VTE and bleeding risk assessments improved to 100%. Prescription of appropriate thromboprophylaxis increased to 48.3%. Modest improvements were observed in VTE risk reassessment (11%) and patient education documentation (33.3%). Persistent gaps were noted in areas influenced by system-level constraints, including the inconsistent availability of prophylactic agents.

CONCLUSION

Low-cost educational interventions can substantially improve VTE risk assessment and documentation in resource-limited settings. However, sustained improvement in thromboprophylaxis delivery requires parallel system-level support, reliable medication access, and integration of reassessment into routine clinical workflows.