Improving Patient Care and Clinical Services: Compliance With the National Institute for Health and Care Excellence (NICE) Guidelines for Venous Thromboembolism Prophylaxis After Hip and Knee Arthroplasty

TL;DR

This study shows how implementing specific measures improved adherence to guidelines for preventing blood clots after hip and knee surgeries.

Contribution

A closed-loop audit and corrective actions significantly increased compliance with VTE prophylaxis guidelines in orthopedic surgery.

Findings

Initial compliance with NICE guidelines for VTE prophylaxis was 90% in the first audit cycle.

After implementing corrective measures, compliance rose to 98% in the second audit cycle.

All THR patients and nearly all TKR patients followed guidelines correctly after interventions.

Abstract

Introduction

Venous Thromboembolism (VTE) prophylaxis is an integral part of post-operative management in trauma and orthopedic surgery. Post-operative VTE prophylaxis, especially in lower limb large joint arthroplasty (LLLJA), helps prevent deep vein thrombosis (DVT) and pulmonary embolism (PE), both of which can lead to significant morbidity and mortality. We audited our practice against the National Institute for Health and Care Excellence (NICE) guidelines for prescribing VTE prophylaxis in post-operative patients who had undergone LLLJA at our hospital.

Methods

This was a closed-loop audit evaluating 95 patients, including 49 who underwent total hip replacements (THR) and 46 who had total knee replacements (TKR). In the first cycle, we reviewed discharge summaries for 48 patients (25 THR and 23 TKR) from January 2024. We presented our initial audit results in May 2024 and introduced four corrective measures. Two months later, in July 2024, we re-audited a further 47 patients (24 undergoing THR and 23 undergoing TKR) and applied statistical analysis to evaluate the changes between the two cycles.

Results

During the first cycle in January 2024, 23 (92%) out of the 25 patients who underwent THR and 20 (87%) out of 23 patients who underwent TKR received VTE prophylaxis in accordance with the NICE guidelines (enoxaparin and anti-embolism stockings). Following implementation of the arthroplasty discharge pack, educational sessions, and nurse-led prescription reviews, the second cycle demonstrated notable improvement, with all 24 (100%) of patients who underwent THR and 22 (96%) of the 23 patients who underwent TKR were managed correctly, resulting in an overall rise in compliance from 90% to 98%.

Conclusion

The introduction of the arthroplasty discharge pack, alongside regular teaching for staff, and final checks by the nurse in charge, increased compliance with the NICE guidelines for VTE prophylaxis in elective hip and knee arthroplasty.

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