The Assessment and Prophylaxis of Venous Thromboembolism in Oral and Maxillofacial Surgery at a University Teaching Hospital: A Quality Improvement Project.

Introduction

The Oral and Maxillofacial Surgery (OMFS) department is unique in its composition of both medical and dental professionals, with the dental team often unfamiliar with the principles of venous thromboembolism (VTE) prophylaxis prior to commencing their  placements. NICE guidelines state all patients should be assessed for VTE risk on admission to hospital. The aims of the QIP involved assessing adherence to this standard in the OMFS department and the extent to which both pharmacological (Enoxaparin) and non-pharmacological prophylaxis (TED stockings) is being prescribed on inpatient drug charts where indicated.

Methods

Baseline data collection was performed to identify areas for performance improvement. 2 PDSA (‘Plan, Do, Study, Act’) cycles were subsequently completed. The intervention in Cycle 1 consisted of a VTE teaching session delivered to the OMFS juniors. The Cycle 2 intervention consisted of the design and display of posters as visual prompts to complete the relevant assessments and prescriptions.

Results

The baseline data collection demonstrated a VTE risk assessment completion rate of 72.5% (29/40). Of the patients assessed to require enoxaparin prophylaxis, this was prescribed on the inpatient drug chart in 85.7% (18/21). Of the patients assessed to be suitable for TED stockings, these were only prescribed on the drug chart in 76% (22/29). Positive change was subsequently demonstrated in Cycle 1 with a risk assessment completion rate of 88% (23/26), enoxaparin prescription completion rate of 95% (19/20) and TEDS prescription rate of 82.6% (19/23). Cycle 2 demonstrated sustained change; risk assessment completion rate of 90% (15/20), enoxaparin prescription rate of 100% (15/15), and TEDS prescription rate of 86.7% (13/15).

Conclusion

Positive change demonstrated across both cycles with improvements across all
parameters. Plan for future FY2 doctors rotating through the department to continue the QIP in order to assess for and implement sustained change over a longer-term period.