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Retrospective audit of venous thromboembolism risk assessment in obstetric postoperative patients at Nottingham University Hospitals

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 Retrospective audit on venous thromboembolism (VTE) risk assessment and prescription of Enoxaparin in obstetric postoperative patients S. Singh, S. Handa, N. Bhandal Nottingham University Hospitals NHS Trust, Nottingham, UK

Introduction: The recent MBRRACE report (Saving Lives, Improving Mother’s Care 2009-2012) again confirms that thrombosis and thromboembolism is a leading cause of direct maternal death with a maternal mortality rate of 0.79 per 100000

maternities . Pregnancy is a prothrombotic state and all women are at increased risk of venous thromboembolism (VTE) during pregnancy and puerperium. At our institute the local guidelines recommend that a risk assessment must be performed for all antenatal women at booking, using the risk assessment tool (Figure 1). This must be repeated at each antenatal admission, in labour and postnatally. Women at risk of VTE should receive low molecular weight Heparin (Enoxaparin) with the dose based on maternal weight and this should be clearly documented in notes. Methods: The aim of this audit was to assess if VTE risk scoring was performed and enoxaparin prescribed as per guidance. This audit was performed over a six month period (February 2014- September 2014) . The case notes of women who had undergone obstetric surgical procedures were reviewed (n=70) and the data was collected on a data collection sheet.

Results: The operative procedures carried out are summarised in figure 2. The VTE risk assessment tool was not appropriately completed in 12/70 (17%) , 22/70 (31.4%) and 36/70 (51%) at booking, antenatal and postnatal visits respectively (Figure 3). All women who underwent an elective caesarean section with a VTE score > 2 and an emergency caesarean section received thromboprophylaxis for the duration of seven days. However 2 women who had an elective CS with VTE score < 2 had thromboprophylaxis for 7 days.

Discussion: This audit has highlighted that during the audit period, there was inadequate use of the VTE risk assessment tool and adherence to local guidance for thromboprophylaxis in pregnancy. In spite of this, postoperative obstetric women were prescribed and received the appropriate dose of enoxaparin. We concluded that there was a need to encourage staff to use the VTE risk assessment tool at each visit and this could be implemented by reinforcing the local VTE guideline as a part of teaching and induction programme for doctors and midwives. We have also suggested that the postoperative thromboprophylaxis plan should be a part of WHO (World Health Organisation) check list and the VTE risk assessment tool should form a part of hand held notes. References

1.Knight M, Kenyon S, Brocklehurst P et al on behalf of MBRRACEUK. Saving Lives, Improving Mothers’ Care - Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. 2. Guideline on the management of thromboprophylaxis in pregnancy available at www.nuh.nhs.uk/handlers/downloads.ashx?id=56295

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