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.