SP5.12 Improving the rate of appropriate prescriptions of thromboprophylaxis in the surgical wards in a DGH with a foundation doctor as QI project lead

Introduction Deep vein thrombosis in hospitalized patients can have severe adverse effects. Pharmacological medication is essential in reducing thromboembolism. Evidence suggests 60% to 75% of surgical patients receive adequate thromboprophylaxis (1). General Surgery at Scunthorpe General Hospital has a 90% thromboprophylaxis prescription rate due to a protocol that requires pharmacological prophylaxis for all patients unless they are actively bleeding. Aim To enhance the rate of appropriate pharmacological thromboprophylaxis for general surgical inpatients from 90% to 95%. Methods PDSA cycles, statistical process control charting First intervention: Doctors in the department were reminded of departmental and NICE guidelines Second intervention: A foundation doctor nominated as QIP lead, checked contemporaneously whether pharmacological thromboprophylaxis was prescribed and provided feedback to colleagues. Third intervention: QIP lead with a small team, contemporaneously prescribed pharmacological thromboprophylaxis not prescribed by admitting teams. Results First intervention: no improvement. Second intervention: improvement with 92% of patients prescribed appropriately. Third intervention: 95% of patients being prescribed appropriate VTE prophylaxis. Our results were statistically significant. Conclusion Our department already had high rates of prescriptions due to process and protocol optimisation. Hence the intervention of reminding doctors of the protocol made no difference. We used a human intervention approach with foundation doctors as leads to achieve 95% appropriate prescription rates Our learning: in areas where the process capability is already high, to obtain higher marginal yet critical gains, leadership from frontline doctors is effective.