Hospital-Associated Thrombosis (HAT) Risk Assessment in Older Medical Inpatients

Introduction
Venous thromboembolism (VTE) is a major preventable cause of hospital-associated morbidity and mortality, particularly in older medical inpatients. Frailty, immobility, multimorbidity, acute illness, and prolonged admission increase VTE risk, while bleeding risk, renal impairment, falls, and polypharmacy complicate thromboprophylaxis decisions. National Institute for Health and Care Excellence guidance recommends clinicians assess all patients for VTE and bleeding risk at admission and reassess if the clinical situation changes. This audit evaluated compliance with VTE prevention standards in an Ageing and Complex Medicine ward at Salford Royal Hospital.

Methods

A retrospective audit of 30 consecutive inpatients admitted to Ward L3 over one month was performed. Electronic patient records were reviewed to assess completion of VTE risk assessment within 24 hours, appropriate pharmacological thromboprophylaxis prescribing, reassessment practices, and documentation of contraindications where applicable. Standards were compared against NICE NG89 guidance and local trust policy.

Results

VTE risk assessment within 24 hours was completed in 83% of patients. Appropriate pharmacological thromboprophylaxis prescribing compliance was 93%, including cases where prophylaxis was prescribed despite incomplete HAT documentation. However, documented VTE reassessment following changes in patients’ clinical condition was documented in only 40% of cases. Additional gaps included inconsistent documentation when pharmacological prophylaxis was withheld, unclear recording of mechanical prophylaxis use, and missed doses related to nursing documentation lapses or medication suspension without documented review.

Conclusion

Overall compliance with VTE prevention standards was good; however, improvement opportunities were identified in reassessment and documentation practices in frail older inpatients. Recommendations included educational reminders, reinforcement of VTE review during multidisciplinary discussions, and optimisation of electronic documentation prompts. A re-audit is planned to assess improvement following implementation of these interventions.