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.