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PM.39 Postnatal Risk Assessment of Venous Thromboembolism (VTE)
  1. DA Banfield1,
  2. LM Page2,
  3. CS Cotzias2,
  4. JC Girling2
  1. 1Imperial College London, London, UK
  2. 2West Middlesex University Hospital, Middlesex, UK

Abstract

VTE is the third leading cause of maternal death in the UK1. In our unit, risk of VTE is assessed using a scoresheet based on RCOG guidelines2, and low molecular weight heparin (LMWH) prescribed according to risk. A recent case of VTE associated with incorrect scoring prompted this audit into the system’s use.

This was a prospective audit, over a 2 week period in October 2012. Spot cheques, carried out on the Postnatal ward, assessed how many women had a completed score sheet, the accuracy of their scores, and identified factors contributing to inaccuracies. When the score indicated a need for LMWH, prescriptions were evaluated.

60 sets of notes were reviewed: 24 women had vaginal deliveries (SVD), 24 delivered by Caesarean section (CS) and 10 had instrumental deliveries (ID).

Only 43 [72%] women had a completed scoresheet: 60% of IDs, 96% of CS, 50% of SVDs. Of these, 74% were scored correctly: 2 were given the wrong LMWH dose. Of the women with incorrect scores, 4 prescribing errors were identified. 2 women without completed scoresheets required LMWH. All 8 prescribing errors were corrected

The audit showed three main types of scoring error: clinical subjectivity, administrative and human factor.

More work is required to encourage staff to consider VTE risk assessment a vital part of a woman’s care. The scoresheet should be included in the delivery notes and become a compulsory part of patient handover. Its use will be reaudited.

References

  1. Centre for maternal and child enquiries. Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer, 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CMACE March 2011.

  2. Royal College of Obstetricians and Gynaecologists. Green top Guideline No.37a: Reducing the risk of Thrombosis and Embolism during Pregnancy and the Puerperium. November 2009.

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