233 Practice of venous thromboembolism risk assessment and prophylaxis administration among admitted patients in a cardiac hospital in Lagos, Nigeria: a quality improvement project

Introduction Venous thromboembolism risk is increased manifold in hospitalised patients, with pulmonary embolism being the most preventable cause of hospital deaths. Proper risk stratification and timely prophylaxis administration are needed to prevent this life-threatening and expensive complication, especially in low- and middle-income countries. This project aimed to audit and improve the practice of venous thromboembolism risk assessment and administration among patients admitted to Meridian Cardiac Center, Lagos, Nigeria. Methods This was a quality improvement project. For the first cycle, a retrospective analysis of clinical records of all patients 18 years and older admitted between 1st September and 31st October 2023 at Meridian Cardiac Center, Festac Town, Lagos, was carried out. The records of 26 admissions were compared to the applicable NICE guideline. In particular, the following were sought: 1) whether the patient had VTE risk assessment was carried out as soon as possible after admission or at the time of the first consultant review using a validated tool; 2) what risk category was the patient; 3) if the patient received pharmacological VTE prophylaxis. The Caprini risk assessment model was introduced on 1st December 2023, following the education of doctors working in the facility. A re-audit using the same guideline was conducted in February 2024 using the records of 18 patients admitted from 1st December 2023 to 9th February 2024. The tool was also used to carry out a retrospective risk scoring for the patients not assessed at admission in both audit cycles. Results In the pre-intervention group, no patient (0%) admitted had their VTE risk assessed at any point during admission. On retrospective data collection, 88.5% were found to be at risk of developing VTE (moderate, high, and highest risk categories). 56.5% of those at risk received VTE prophylaxis while on admission. In the second cycle, 56.6% of admitted patients had their VTE risk assessment scoring completed, with 94.4% of all those admitted (assessed either at admission or retrospectively) being at risk of developing VTE. Of this, 64.7% received VTE prophylaxis. Conclusion The audit identified poor compliance with NICE guidelines, with some improvement in the second cycle. Clinical education on the potential harm improved the occurrence of VTE risk assessment at admission as well as the administration of prophylaxis to at-risk patients. Identifying barriers to the local application of international standards will form the basis of future audits. Systematic and proper documentation of clinical notes will go a long way in enhancing the results obtained from these audits. Conflict of Interest Nil