J Thromb Thrombolysis DOI 10.1007/s11239-015-1224-4
Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic Adam Haymes1
Ó Springer Science+Business Media New York 2015
Abstract Each year venous thromboembolism (VTE) causes up to 60,000 deaths in the UK, many resulting from hospital-acquired thromboses following elective surgery. National Institute for Health and Clinical Excellence (NICE) guidelines state that all elective surgical patients should receive verbal and written information pre-operatively regarding the risks of developing VTE. This audit assessed elective surgical patient’s prior awareness of VTE and examined how effective targeted patient education during the pre-operative assessment is in increasing this awareness. A 13 point questionnaire designed to assess a pre-operative patient’s understanding of topics relating to VTE was provided to consecutive patients identified as being at risk of developing VTE at the end of their pre-operative assessment over a two-week period. A total of 68 questionnaires were completed. Provision of verbal and written information was poor (47 %, n = 32 and 47 %, n = 32 respectively). Despite this, 71 % (n = 48) of patients were aware of the consequences of developing VTE. Many patients correctly identified surgery (71 %, n = 48), immobility (71 %, n = 48) and being overweight (68 %, n = 46) as risk factors, but not dehydration (47 %, n = 32). Lack of awareness regarding personal methods to reduce the risk of developing a VTE post-operatively (24 %, n = 16) and potential side-
The paper was presented as a poster at the Association of Surgeons of Great Britain and Northern Ireland (ASGBI) 2014 Annual Conference. The corresponding abstract was published in a supplement of the British Journal of Surgery (BJS 2015;102 (S1):275) [1]. & Adam Haymes [email protected] 1
Department of Otolaryngology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH, UK
effects of medical prophylaxis (32 %, n = 22) were also identified. Many patients already possess an awareness of VTE, however, specific knowledge regarding its risk factors and methods of prevention is lacking. Provision of targeted written and verbal educational information during the preoperative assessment is an effective method of increasing a patient’s awareness of these topics. Increased patient awareness may empower patients in their post-operative recovery and enable them to make more informed decisions regarding VTE prophylaxis options. Keywords Thromboembolism, venous Education of patients Perioperative care Surgery Abbreviations VTE Venous thromboembolism DVT Deep vein thrombosis PE Pulmonary embolism MRSA Methicillin resistant Staphylococcus aureus CG92 Clinical guideline 92 NICE National Institute for Health and Clinical Excellence CCG-OIS Clinical commissioning groups outcomes indicator set CQC Care quality commission CQUIN Commissioning for quality and innovation
Background Venous thromboembolism (VTE) constitutes a spectrum of thromboembolic disease including deep vein thrombosis (DVT) and pulmonary embolism (PE). These diseases collectively account for one of the leading causes of morbidity and mortality in hospitalised patients. In the UK,
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VTE has been estimated to cause between 25,000 [2] and 60,000 [3] deaths annually in hospitalised patients, more than 10 times the number of deaths caused annually by methicillin resistant Staphylococcus aureus (MRSA) bacteraemia. In the US the number of affected patients has been estimated to be as high as 600,000 annually, more than five times the combined total number of deaths from breast cancer, AIDS, and road traffic accidents in the same population [4]. The treatment of non-fatal symptomatic VTE and associated long-term morbidities costs the NHS up to £640 million a year to manage [2]. Thus, VTE is a substantial global healthcare problem resulting in significant mortality, morbidity and socioeconomic cost. It is also likely to be an increasing public health problem in our ageing society due to the prominence of age as a risk factor [5]. The prevention of VTE in hospitalised patients has been a national clinical priority for the NHS since the publication of clinical guideline 92 (CG92) by the National Institute for Health and Clinical Excellence (NICE) in 2010 [6]. These guidelines outline a comprehensive, evidencebased and up-to-date set of best practice recommendations to prevent VTE in adult patients admitted to hospital [7, 8]. Based on these guidelines VTE-specific indicators have been worked into the NHS Outcomes Framework, Clinical Commissioning Groups Outcomes Indicator Set (CCGOIS) and the Care Quality Commission’s (CQC) Intelligent Monitoring model. Furthermore, VTE prevention forms one of the national goals of the Commissioning for Quality and Innovation (CQUIN) payment framework, meaning all NHS trusts in the UK are required to show auditable evidence of VTE risk-assessment and prophylaxis administration when applicable [7]. CG92 also includes the recommendation that all patients should receive verbal and written information on the risks and consequences of developing VTE, the possible side effects of prophylaxis and risk reduction strategies, prior to starting prophylaxis. This advice is based on findings that there is relatively little awareness of the dangers of VTE in the public domain [9, 10] and that patient refusal is often a common reason for omitted doses of prophylactic heparins [11]. It has been demonstrated that education on the sideeffects of prophylactic treatment is not necessarily associated with its refusal by patients [11]. Thus, a targeted patient education programme that addresses individuals needs and preferences will be important in achieving satisfactory levels of concordance and allowing patients to make informed decisions in partnership with their healthcare providers [6]. This audit was designed to assess the level of verbal and written information provided to patients identified as being at risk of developing VTE (and thus requiring prophylactic treatment) in a pre-operative assessment clinic. The audit
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also aimed to assess the effectiveness of the information provided in raising a patients’ level of awareness on topics surrounding VTE as per CG92 recommendations, and to identify gaps in patient’s knowledge in order to inform the development of a more targeted education programme.
Methods Ethical approval was obtained from the clinical audit department of Croydon University NHS Trust in March 2013. The study was conducted in the pre-operative assessment clinic of the same trust which serves a population of 380,000 [12] and conducts approximately 27,000 operations a year requiring pre-operative assessment [13]. All patients had their clinical risk of developing VTE stratified using NHS standardised risk-assessment tables as part of the pre-operative assessment appointment [6]. Those identified as being at ‘high’ or ‘moderate’ risk of developing VTE would subsequently be prescribed prophylactic interventions before, during and after their surgery according to CG92 recommendations. The nursing staff conducting the pre-operative assessment clinics had been instructed to provide verbal and written information regarding the risks, signs and treatments of VTE to any patient identified as being ‘at risk’. However, there was no hospital policy nor accepted standardised approach to the provision of this information, nor had adherence to its provision been previously measured. As such, to ensure a fair representation of the current practice of the pre-operative assessment clinic as a whole, the nursing staff conducting the assessments were blinded to the existence and content of the questionnaires. Following the patient’s pre-operative assessment those patients identified as having a ‘high’ or ‘moderate’ risk of developing VTE, and thus to be prescribed prophylactic measures, were approached before leaving the clinic. Informed verbal consent was obtained and the patients were provided with an anonymous questionnaire to complete. Eighty consecutive patients over a two-week period were approached and 68 (85 %) completed and returned the questionnaires. The questionnaires were in the form of 13 yes/no questions (Fig. 1) and were designed to assess the level of awareness of VTE following the pre-operative assessment consultation.
Results A total of 68 questionnaires were completed over the 2-week period. Sixty-two percent (62 %, n = 42) of responders were female, and 38 % (n = 26) were male. The median age of responders was 56 (range 22–83 years).
Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic Fig. 1 Questionnaire provided to patients at the end of their pre-operative assessment
Provision of written and verbal information to patients regarding VTE was generally low (47 %, n = 32 and 47 %, n = 32 respectively). Twenty-four patients were provided with both written and verbal information (35 %, n = 24), eight patients with verbal information only (12 %, n = 8), eight patients with written information only (12 %, n = 8), and 28 patients with neither written nor verbal information (41 %, n = 28).
Awareness of risk factors associated with developing VTE were readily identified in those who had received verbal plus written information (surgery 92 %, n = 22; immobility 92 %, n = 22; being overweight 92 %, n = 22; dehydration 83 %, n = 20) and verbal information alone (75 %, n = 6). Awareness was lacking in those who received only written information (surgery 25 %, n = 2; immobility 25 %, n = 2; being overweight 25 %, n = 2;
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dehydration 0 %, n = 0). Some patients displayed a level of awareness of risk factors for developing VTE despite not receiving any written or verbal information on the subject during the pre-operative assessment (dehydration 21 %, n = 6; being overweight 57 %, n = 18; surgery 64 %, n = 18; immobility 64 %, n = 18). Less than half of all the responders were aware that dehydration was a risk factor for developing VTE (47 %, n = 32). Most patients reported being aware of the consequences of developing a VTE (71 %, n = 48) even if no written or verbal information was provided on the topic during the consultation (57 %, n = 16). Similarly, there was some overall awareness of medical methods of VTE prophylaxis (53 %, n = 36), most pronounced in those who received both written and verbal information (92 %, n = 22). There was comparatively less awareness of the potential sideeffects of these methods in all patients (32 %, n = 22). Most patients were aware of the need to wear anti-embolic stockings as a method to prevent VTE (74 %, n = 50), but far fewer were aware of the correct way to wear them (35 %, n = 24). Relatively few patients were aware of the signs and symptoms of a DVT (32 %, n = 22) or of personal methods one could take to reduce the risk of developing a VTE post-operatively (24 %, n = 16).
Whilst the provision of written and verbal information was generally poor in the pre-operative assessment encounter (47 %, n = 32 and 47 %, n = 32 respectively), this audit has demonstrated that the content of the current information provided is effective in increasing patient awareness regarding various aspects of VTE. Awareness of risk factors pre-disposing to VTE rose from a mean 52 % (mean n = 15) in those not receiving any information during the consultation to a mean 90 % (mean n = 22) in those receiving both written and verbal information. Similarly, awareness of medical prophylactic measures (36 %, n = 10) and their side-effects (0 %) rose significantly with the provision of both verbal and written information (92 %, n = 22 and 75 %, n = 18 respectively). The increase in awareness of other aspects was less significant, including a 21 % increase in the correct way to wear anti-embolic stockings (29 %, n = 8; to 50 %, n = 12) and a 28 % increase in awareness of personal methods to employ post-operatively to reduce the risk of developing VTE (14 %, n = 4; to 42 %, n = 10). These are both aspects that, if addressed appropriately, could have a potentially large impact on a patient’s overall risk of developing a VTE.
Conclusions Discussion All NHS trusts in the UK are required to show auditable evidence of VTE risk-assessment, prophylaxis administration and provision of verbal and written information regarding the risks of developing a VTE [7]. As such, this audit examined the levels of information provision during the pre-operative assessment clinic and indirectly the quality of this provision by assessing the level of patient awareness regarding specific points highlighted in NICE guidelines. The pre-operative assessment clinic offers an ideal opportunity to educate patients on various aspects of their elective surgery, including the potential post-operative complication of VTE. The appointment offers a safe and structured encounter in which to address patient’s concerns, identify gaps in their knowledge and provide targeted education as appropriate. This audit has highlighted such gaps, including knowledge of the signs and symptoms of a DVT (14 %, n = 4), the side-effects of prophylactic treatments (0 %) and of knowing to avoid dehydration in order to reduce the risk of developing a VTE (21 %, n = 6). Addressing these and other aspects will be important in ensuring that patients are able to make fully informed decisions regarding their surgery and any prophylactic treatments prescribed.
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Educating elective surgical patients regarding their risks of developing VTE now forms an auditable part of the perioperative pathway. The pre-operative assessment clinic offers an ideal opportunity to provide this targeted education. Some patients appear to have a prior awareness of specific factors relating to VTE whilst others are less familiar. Providing verbal and written information during the pre-operative assessment clinic is an effective method to increase a patient’s awareness of VTE and may help to increase compliance with prophylactic treatments.
Conflict of interest
None.
References 1. Haymes A (2015) Venous thromboembolism: patient awareness in pre-operative assessment clinic. Br J Surg 102(S1):275 2. House of Commons Health Committee (2005) The prevention of venous thromboembolism in hospitalised patients. House of Commons, London 3. Cohen AT, Kakkar AK (2005) Venous thromboembolic disease in cancer patients in Europe—an opportunity for improved prevention: the VITAE thrombosis study. Eur J Cancer 3(suppl 2):155 4. Fitzmaurice DA, Murray E (2007) Thromboprophylaxis for adults in hospital. BMJ 334:1017–1018
Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic 5. Network Scottish Intercollegiate Guidelines (2010) Prevention and management of venous thromboembolism. SIGN, Edinburgh 6. National Institute for Clinical Excellence (2007) Venous thromboembolism: reducing the risk of thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. NICE, London 7. All-Party Parliamentary Thrombosis Group (2012) APPTG annual survey results 2012—national overview. APPTG, London 8. National Collaborating Centre for Acute Care (2007) Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery: methods, evidence and guidance. National Collaborating Centre for Acute Care, London 9. Torbicki A, van Beek EJR, Charbonnier B et al (2000) Task force report: guidelines on the diagnosis and management of acute pulmonaryembolism. Eur Heart J 21:1301
10. Association American Public Health (2002) DVT omnibus survey 2002. APHA, Washington, DC 11. Lubenow N, Hinz P, Ekkernkamp A et al (2007) Should patients be informed about the risk of heparin induced thrombocytopaenia before prolonged low-molecular weight heparin thromboprophylaxis post trauma/orthopaedic surgery? Eur J Haematol 79:187–190 12. Croydon Health Services NHS Trust. Statement of purpose. http://www.croydonhealthservices.nhs.uk/downloads/Corporate_ Information/Croydon%20Health%20Services%20-%20Statement% 20of%20Purpose.pdf. Accessed 9 Nov 2013 13. Croydon Health Services NSHS Trust. Annual review 2013–2014. http://www.croydonhealthservices.nhs.uk/Downloads/Annual%20 Reports/Croydon%20Health%20Services%20Annual%20Review% 202013-14.pdf. Accessed 25 April 2015
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Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic Adam Haymes1
Ó Springer Science+Business Media New York 2015
Abstract Each year venous thromboembolism (VTE) causes up to 60,000 deaths in the UK, many resulting from hospital-acquired thromboses following elective surgery. National Institute for Health and Clinical Excellence (NICE) guidelines state that all elective surgical patients should receive verbal and written information pre-operatively regarding the risks of developing VTE. This audit assessed elective surgical patient’s prior awareness of VTE and examined how effective targeted patient education during the pre-operative assessment is in increasing this awareness. A 13 point questionnaire designed to assess a pre-operative patient’s understanding of topics relating to VTE was provided to consecutive patients identified as being at risk of developing VTE at the end of their pre-operative assessment over a two-week period. A total of 68 questionnaires were completed. Provision of verbal and written information was poor (47 %, n = 32 and 47 %, n = 32 respectively). Despite this, 71 % (n = 48) of patients were aware of the consequences of developing VTE. Many patients correctly identified surgery (71 %, n = 48), immobility (71 %, n = 48) and being overweight (68 %, n = 46) as risk factors, but not dehydration (47 %, n = 32). Lack of awareness regarding personal methods to reduce the risk of developing a VTE post-operatively (24 %, n = 16) and potential side-
The paper was presented as a poster at the Association of Surgeons of Great Britain and Northern Ireland (ASGBI) 2014 Annual Conference. The corresponding abstract was published in a supplement of the British Journal of Surgery (BJS 2015;102 (S1):275) [1]. & Adam Haymes [email protected] 1
Department of Otolaryngology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH, UK
effects of medical prophylaxis (32 %, n = 22) were also identified. Many patients already possess an awareness of VTE, however, specific knowledge regarding its risk factors and methods of prevention is lacking. Provision of targeted written and verbal educational information during the preoperative assessment is an effective method of increasing a patient’s awareness of these topics. Increased patient awareness may empower patients in their post-operative recovery and enable them to make more informed decisions regarding VTE prophylaxis options. Keywords Thromboembolism, venous Education of patients Perioperative care Surgery Abbreviations VTE Venous thromboembolism DVT Deep vein thrombosis PE Pulmonary embolism MRSA Methicillin resistant Staphylococcus aureus CG92 Clinical guideline 92 NICE National Institute for Health and Clinical Excellence CCG-OIS Clinical commissioning groups outcomes indicator set CQC Care quality commission CQUIN Commissioning for quality and innovation
Background Venous thromboembolism (VTE) constitutes a spectrum of thromboembolic disease including deep vein thrombosis (DVT) and pulmonary embolism (PE). These diseases collectively account for one of the leading causes of morbidity and mortality in hospitalised patients. In the UK,
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A. Haymes
VTE has been estimated to cause between 25,000 [2] and 60,000 [3] deaths annually in hospitalised patients, more than 10 times the number of deaths caused annually by methicillin resistant Staphylococcus aureus (MRSA) bacteraemia. In the US the number of affected patients has been estimated to be as high as 600,000 annually, more than five times the combined total number of deaths from breast cancer, AIDS, and road traffic accidents in the same population [4]. The treatment of non-fatal symptomatic VTE and associated long-term morbidities costs the NHS up to £640 million a year to manage [2]. Thus, VTE is a substantial global healthcare problem resulting in significant mortality, morbidity and socioeconomic cost. It is also likely to be an increasing public health problem in our ageing society due to the prominence of age as a risk factor [5]. The prevention of VTE in hospitalised patients has been a national clinical priority for the NHS since the publication of clinical guideline 92 (CG92) by the National Institute for Health and Clinical Excellence (NICE) in 2010 [6]. These guidelines outline a comprehensive, evidencebased and up-to-date set of best practice recommendations to prevent VTE in adult patients admitted to hospital [7, 8]. Based on these guidelines VTE-specific indicators have been worked into the NHS Outcomes Framework, Clinical Commissioning Groups Outcomes Indicator Set (CCGOIS) and the Care Quality Commission’s (CQC) Intelligent Monitoring model. Furthermore, VTE prevention forms one of the national goals of the Commissioning for Quality and Innovation (CQUIN) payment framework, meaning all NHS trusts in the UK are required to show auditable evidence of VTE risk-assessment and prophylaxis administration when applicable [7]. CG92 also includes the recommendation that all patients should receive verbal and written information on the risks and consequences of developing VTE, the possible side effects of prophylaxis and risk reduction strategies, prior to starting prophylaxis. This advice is based on findings that there is relatively little awareness of the dangers of VTE in the public domain [9, 10] and that patient refusal is often a common reason for omitted doses of prophylactic heparins [11]. It has been demonstrated that education on the sideeffects of prophylactic treatment is not necessarily associated with its refusal by patients [11]. Thus, a targeted patient education programme that addresses individuals needs and preferences will be important in achieving satisfactory levels of concordance and allowing patients to make informed decisions in partnership with their healthcare providers [6]. This audit was designed to assess the level of verbal and written information provided to patients identified as being at risk of developing VTE (and thus requiring prophylactic treatment) in a pre-operative assessment clinic. The audit
123
also aimed to assess the effectiveness of the information provided in raising a patients’ level of awareness on topics surrounding VTE as per CG92 recommendations, and to identify gaps in patient’s knowledge in order to inform the development of a more targeted education programme.
Methods Ethical approval was obtained from the clinical audit department of Croydon University NHS Trust in March 2013. The study was conducted in the pre-operative assessment clinic of the same trust which serves a population of 380,000 [12] and conducts approximately 27,000 operations a year requiring pre-operative assessment [13]. All patients had their clinical risk of developing VTE stratified using NHS standardised risk-assessment tables as part of the pre-operative assessment appointment [6]. Those identified as being at ‘high’ or ‘moderate’ risk of developing VTE would subsequently be prescribed prophylactic interventions before, during and after their surgery according to CG92 recommendations. The nursing staff conducting the pre-operative assessment clinics had been instructed to provide verbal and written information regarding the risks, signs and treatments of VTE to any patient identified as being ‘at risk’. However, there was no hospital policy nor accepted standardised approach to the provision of this information, nor had adherence to its provision been previously measured. As such, to ensure a fair representation of the current practice of the pre-operative assessment clinic as a whole, the nursing staff conducting the assessments were blinded to the existence and content of the questionnaires. Following the patient’s pre-operative assessment those patients identified as having a ‘high’ or ‘moderate’ risk of developing VTE, and thus to be prescribed prophylactic measures, were approached before leaving the clinic. Informed verbal consent was obtained and the patients were provided with an anonymous questionnaire to complete. Eighty consecutive patients over a two-week period were approached and 68 (85 %) completed and returned the questionnaires. The questionnaires were in the form of 13 yes/no questions (Fig. 1) and were designed to assess the level of awareness of VTE following the pre-operative assessment consultation.
Results A total of 68 questionnaires were completed over the 2-week period. Sixty-two percent (62 %, n = 42) of responders were female, and 38 % (n = 26) were male. The median age of responders was 56 (range 22–83 years).
Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic Fig. 1 Questionnaire provided to patients at the end of their pre-operative assessment
Provision of written and verbal information to patients regarding VTE was generally low (47 %, n = 32 and 47 %, n = 32 respectively). Twenty-four patients were provided with both written and verbal information (35 %, n = 24), eight patients with verbal information only (12 %, n = 8), eight patients with written information only (12 %, n = 8), and 28 patients with neither written nor verbal information (41 %, n = 28).
Awareness of risk factors associated with developing VTE were readily identified in those who had received verbal plus written information (surgery 92 %, n = 22; immobility 92 %, n = 22; being overweight 92 %, n = 22; dehydration 83 %, n = 20) and verbal information alone (75 %, n = 6). Awareness was lacking in those who received only written information (surgery 25 %, n = 2; immobility 25 %, n = 2; being overweight 25 %, n = 2;
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dehydration 0 %, n = 0). Some patients displayed a level of awareness of risk factors for developing VTE despite not receiving any written or verbal information on the subject during the pre-operative assessment (dehydration 21 %, n = 6; being overweight 57 %, n = 18; surgery 64 %, n = 18; immobility 64 %, n = 18). Less than half of all the responders were aware that dehydration was a risk factor for developing VTE (47 %, n = 32). Most patients reported being aware of the consequences of developing a VTE (71 %, n = 48) even if no written or verbal information was provided on the topic during the consultation (57 %, n = 16). Similarly, there was some overall awareness of medical methods of VTE prophylaxis (53 %, n = 36), most pronounced in those who received both written and verbal information (92 %, n = 22). There was comparatively less awareness of the potential sideeffects of these methods in all patients (32 %, n = 22). Most patients were aware of the need to wear anti-embolic stockings as a method to prevent VTE (74 %, n = 50), but far fewer were aware of the correct way to wear them (35 %, n = 24). Relatively few patients were aware of the signs and symptoms of a DVT (32 %, n = 22) or of personal methods one could take to reduce the risk of developing a VTE post-operatively (24 %, n = 16).
Whilst the provision of written and verbal information was generally poor in the pre-operative assessment encounter (47 %, n = 32 and 47 %, n = 32 respectively), this audit has demonstrated that the content of the current information provided is effective in increasing patient awareness regarding various aspects of VTE. Awareness of risk factors pre-disposing to VTE rose from a mean 52 % (mean n = 15) in those not receiving any information during the consultation to a mean 90 % (mean n = 22) in those receiving both written and verbal information. Similarly, awareness of medical prophylactic measures (36 %, n = 10) and their side-effects (0 %) rose significantly with the provision of both verbal and written information (92 %, n = 22 and 75 %, n = 18 respectively). The increase in awareness of other aspects was less significant, including a 21 % increase in the correct way to wear anti-embolic stockings (29 %, n = 8; to 50 %, n = 12) and a 28 % increase in awareness of personal methods to employ post-operatively to reduce the risk of developing VTE (14 %, n = 4; to 42 %, n = 10). These are both aspects that, if addressed appropriately, could have a potentially large impact on a patient’s overall risk of developing a VTE.
Conclusions Discussion All NHS trusts in the UK are required to show auditable evidence of VTE risk-assessment, prophylaxis administration and provision of verbal and written information regarding the risks of developing a VTE [7]. As such, this audit examined the levels of information provision during the pre-operative assessment clinic and indirectly the quality of this provision by assessing the level of patient awareness regarding specific points highlighted in NICE guidelines. The pre-operative assessment clinic offers an ideal opportunity to educate patients on various aspects of their elective surgery, including the potential post-operative complication of VTE. The appointment offers a safe and structured encounter in which to address patient’s concerns, identify gaps in their knowledge and provide targeted education as appropriate. This audit has highlighted such gaps, including knowledge of the signs and symptoms of a DVT (14 %, n = 4), the side-effects of prophylactic treatments (0 %) and of knowing to avoid dehydration in order to reduce the risk of developing a VTE (21 %, n = 6). Addressing these and other aspects will be important in ensuring that patients are able to make fully informed decisions regarding their surgery and any prophylactic treatments prescribed.
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Educating elective surgical patients regarding their risks of developing VTE now forms an auditable part of the perioperative pathway. The pre-operative assessment clinic offers an ideal opportunity to provide this targeted education. Some patients appear to have a prior awareness of specific factors relating to VTE whilst others are less familiar. Providing verbal and written information during the pre-operative assessment clinic is an effective method to increase a patient’s awareness of VTE and may help to increase compliance with prophylactic treatments.
Conflict of interest
None.
References 1. Haymes A (2015) Venous thromboembolism: patient awareness in pre-operative assessment clinic. Br J Surg 102(S1):275 2. House of Commons Health Committee (2005) The prevention of venous thromboembolism in hospitalised patients. House of Commons, London 3. Cohen AT, Kakkar AK (2005) Venous thromboembolic disease in cancer patients in Europe—an opportunity for improved prevention: the VITAE thrombosis study. Eur J Cancer 3(suppl 2):155 4. Fitzmaurice DA, Murray E (2007) Thromboprophylaxis for adults in hospital. BMJ 334:1017–1018
Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic 5. Network Scottish Intercollegiate Guidelines (2010) Prevention and management of venous thromboembolism. SIGN, Edinburgh 6. National Institute for Clinical Excellence (2007) Venous thromboembolism: reducing the risk of thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. NICE, London 7. All-Party Parliamentary Thrombosis Group (2012) APPTG annual survey results 2012—national overview. APPTG, London 8. National Collaborating Centre for Acute Care (2007) Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery: methods, evidence and guidance. National Collaborating Centre for Acute Care, London 9. Torbicki A, van Beek EJR, Charbonnier B et al (2000) Task force report: guidelines on the diagnosis and management of acute pulmonaryembolism. Eur Heart J 21:1301
10. Association American Public Health (2002) DVT omnibus survey 2002. APHA, Washington, DC 11. Lubenow N, Hinz P, Ekkernkamp A et al (2007) Should patients be informed about the risk of heparin induced thrombocytopaenia before prolonged low-molecular weight heparin thromboprophylaxis post trauma/orthopaedic surgery? Eur J Haematol 79:187–190 12. Croydon Health Services NHS Trust. Statement of purpose. http://www.croydonhealthservices.nhs.uk/downloads/Corporate_ Information/Croydon%20Health%20Services%20-%20Statement% 20of%20Purpose.pdf. Accessed 9 Nov 2013 13. Croydon Health Services NSHS Trust. Annual review 2013–2014. http://www.croydonhealthservices.nhs.uk/Downloads/Annual%20 Reports/Croydon%20Health%20Services%20Annual%20Review% 202013-14.pdf. Accessed 25 April 2015
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