Abstract
Background
The prevention of hospital associated thrombosis in palliative care remains controversial
yet many countries recommend the documented risk assessment and where appropriate
pharmacological prophylaxis of inpatients with advanced cancer.
Aim
To audit adherence to national guidelines which require hospitalised patients to be
risk assessed and receive appropriate thromboprophylaxis.
Design
A one day “flash-mob” audit across multiple clinical inpatient sites across the United
Kingdom.
Setting/participants
Inpatients receiving palliative care within hospitals, hospices and specialist palliative
care units across the United Kingdom.
Results
Data were collected from 1125 patients (514 hospital and 611 hospice/specialist palliative
care units). Appropriate thromboprophylaxis was observed in 90 % of hospital and 90 %
hospice/specialist palliative care units. Documented risk assessment was only found
in 79 % and 71 % of patient notes respectively. Pharmacological thromboprophylaxis
was contraindicated in 88 % of hospice/specialist palliative care unit patients due
to bleeding risk or receiving end-of-life care. Twenty-four percent of patients in
hospital had contraindications due to receiving end of life care, bleeding risk and
thrombocytopenia. Patients in hospice/specialist palliative care units were of poorer
performance status prior to admission with a history of gradual deterioration. Hospitalised
patients were more likely to have been admitted following an acute deterioration of
previous good performance status.
Conclusion
Thromboprophylaxis guidelines were followed correctly for the majority of patients.
There were considerable differences in the demographics of patients according to place
of admission. Patients admitted to hospice/specialist palliative care units were sicker
and had more contraindications to prophylaxis than those admitted to hospital. Thromboprophylaxis
focused research data conducted in hospices is unlikely to be applicable to the care
of palliative care patients admitted acutely to hospital.
Keywords
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Article info
Publication history
Published online: January 25, 2023
Accepted:
January 20,
2023
Received in revised form:
January 17,
2023
Received:
December 24,
2022
Identification
Copyright
Crown Copyright © 2023 Published by Elsevier Ltd. All rights reserved.
