Getting a Validated Guideline into Local Practice: Implementation and Audit of the Sign Guideline on the Prevention of Deep Vein Thrombosis in a District General Hospital

Abstract

This paper describes the implementation of a specific clinical guideline on venous thromboprophylaxis and outlines the audit design and methods used to achieve this objective. A member of the clinical staff was seconded to oversee this implementation and co-ordinate audit of current practice in the main clinical specialties within the trust. The Trust Clinical Audit Committee agreed to fund this low cost initiative (approximately £3,800) from clinical guideline monies. Findings from the initial audit revealed a total of 224 patients identified as ‘at risk’ of developing deep vein thrombosis or pulmonary embolism. Of this number 72.8%, (n=163), were prescribed prophylaxis compared with the pre-set standard of 90.0%. Fifty four percent, (n=122), of all identified patients were prescribed the correct prophylaxis in accordance with SIGN guideline recommendations. As a result of the initial findings local prevention protocols were developed or upgraded as required in line with the national guideline. The repeat audit findings highlighted a significant increase in the number of ‘at risk‘ patients prescribed prophylaxis rising from 72.8% to 97.4% (P<0.001) and similarly from 54.5% to 95.9% for those prescribed the correct prophylaxis (P<0.001).