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.
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.
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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