Abstract
Due to working time restrictions a full-shift cross-covering system is commonplace. As more than one surgeon is responsible for trauma admissions in a 24-hour period a complete handover is paramount to ensure continuity of care.
The purpose of this audit was to determine whether the introduction of a formal handover/admission form would improve this continuity with regards to prescription of venous thromboembolism (VTE) prophylaxis in hip fracture patients.
In Stirling Royal Infirmary chemical VTE prophylaxis for hip fracture patients is 40mg enoxaparin at 6pm unless there is a contraindication. Over a 14-day period we prospectively documented the prescription of VTE prophylaxis and doses missed under the current admissions system. Following this a proforma was introduced that was to be exchanged at handover meetings. The proforma included patients' name/details, admission ward, and tasks to be completed during clerk-in, including VTE prophylaxis prescription. Tasks outstanding at handover had to be documented and completed by the subsequent doctor. Each form was signed and dated by the receiving doctor. We subsequently re-evaluated the prescription of VTE prophylaxis in hip fracture patients.
Between 1/12/10-15/12/10, 23 patients were admitted with hip fracture. 12 had appropriate VTE prophylaxis, 6 missed one dose, 4 missed two, and 1 missed three all due to failure of prescription.
Following the introduction of the proforma, 12 patients were admitted with hip fractures between 31/12/10-14/1/11. All were prescribed appropriate VTE prophylaxis and missed no doses. 1 patient was on warfarin and had enoxaparin prescribed but withheld until INR< 2.0.
After the introduction of a handover form VTE prophylaxis prescription vastly improved. This proforma ensured that all elements of initial management were completed allowing for physician accountability, greater efficacy of handover and continuity of care.
