Authors (including presenting author) :
Wong L (1), Chow R (2), Lau YC (1), Ho SL (1), Suen TKD(1), Kwong A(1)
Affiliation :
(1) Department of Surgery, Queen Mary Hospital, and Tung Wah Hospital (2) Department of Occupational Therapy, Tung Wah Hospital
Introduction :
In response to the recent increase in venous thromboembolism (VTE) cases this year, a comprehensive review of existing guidelines was conducted. The revised guidelines incorporate new evidence, and emphasize prevention strategies. Subsequently, patient education and staff training were enhanced to ensure adherence to these guidelines.
Objectives :
The objectives are to enhance evidence-based practices and ensure adherence to the guidelines.
Methodology :
From June to September 2024, a comprehensive review of VTE guidelines were conducted; which were endorsed by the multi-disciplinary team. The duration of surgery, a significant risk factor for VTE, was incorporated into the existing Autar scale for a more comprehensive assessment. To improve compliance with graduated compression stockings (GCS), the guidelines now recommend knee-level instead of thing-level stockings. While recent evidence regarding the combination of GCS with intermittent pneumatic compression (IPC) is more effective compared to GCS only, the guidelines recommend using both mechanical preventive methods together during operation. A comprehensive patient education program was introduced, focusing on the key peri-operative preventive measures, including smoking cessation, regular exercise and ankle movement, adequate hydration, keeping legs warm, early mobilization after surgery, recognition of VTE signs and symptoms. At the meantime, training programs were conducted to ensure all staff who are providing care for breast cancer surgical patients are current with the latest guidelines and best practices for VTE prevention. Since October 2024, the revised guidelines have been implemented at Queen Mary and Tung Wah Hospitals for patients undergoing breast cancer surgery.
Result & Outcome :
Results: There were no reported cases (0/107) of VTE from October to December, compared to a 0.1% (3/302) incidence rate in the first three quarters of the year. The compliance rate for knee-length GCS was 98.5% (61/62), compared to 74.5% (88/118) for thigh-length stockings. Additionally, 90% (100/108) of patients demonstrated understanding and adherence to all items of the new guidelines. A clinical audit conducted in November 2024 revealed that 100 percent of the staff (n=6) at the Breast Centre adhered to the new clinical guidelines. Conclusion: Short-term data indicates that the new guidelines effectively enhance VTE prevention and maintain high standards of patient care for those undergoing breast cancer surgery. Ongoing data analysis and clinical audits will continue to evaluate these outcomes and identify areas for further improvement.
