Optimising Venous Thrombosis prophylaxis documentation and prescribing in stroke patients, a multi-cycle, quality improvement

Introduction: Venous thromboembolism (VTE) is a common complication in post-stroke patients, with an incidence of approximately 17%. Pulmonary embolism accounts for 25–50% of reported VTE-related deaths. Pharmacological prophylaxis with low-molecular-weight heparin (LMWH) is contraindicated within the first 30 days following stroke due to the risk of haemorrhagic transformation and clot instability. As an alternative, mechanical prophylaxis using intermittent pneumatic compression (IPC) has demonstrated efficacy in reducing VTE incidence and improving survival outcomes. Evidence from the CLOTS 3 trial supports the use of IPC as an effective method of VTE prophylaxis.

Methods: Seventy-three patients were sampled across three-point audits completed in May, July and August 2025. To increase awareness of VTE documentation, we introduced a VTE column on the stroke ward patient board, prompting VTE documentation to be discussed on the daily MDT board rounds. A teaching session was held, to educate resident doctors, and expand awareness. As a second intervention, a poster was produced, with prescribing guidelines and posted on the stroke ward, and in the medical on-call office. 

Results: Initial audit data showed 91.7% of patients had appropriate VTE prophylaxis prescribed. However, this decreased by 12.5% in the second cycle. VTE decision documentation was present in 50% of cases initially, improving by 33.3% after the first intervention. After the second intervention, documentation increased by a further 2%, and prescribing accuracy improved by 3.4%. Correct dosing remained at 100% across all three cycles.

Conclusion: The interventions saw a total increase in correct VTE prescribing and documenting. Ensuring 100% adherence is vital to prevent adverse VTE outcomes. Further teaching sessions would alert staff to the importance of VTE documentation and correct prescribing. Expanding the placement of poster intervention onto more wards, may further awareness and will likely improve patient outcomes.