Post‐caesarean section venous thromboembolic prescription: do we need a defined prescriber role?
Published Date: 01st September 2020
Publication Authors: Robinson E, Singh P
Venous thromboembolic (VTE) disease remains an important cause of perinatal morbidity and mortality [1]. All patients undergoing a caesarean section (CS) ‘should be considered for thromboprophylaxis with low molecular weight heparin (LMWH) for 10 days after delivery’, as per Royal College of Obstetricians [2]. Anecdotally, within our region, the responsibly of VTE prophylaxis prescription varies in different hospitals. Our Trust does not specify whether the assessment, and prescription, should be done by the obstetric or anaesthetic team. It could be suggested that inconsistency, a lack of a defined prescriber and frequent trainee rotations, may lead to suboptimal VTE prescription in this high‐risk group of patients with potentially serious consequences.
Methods
Data on current practice were collected retrospectively from clinical notes and drug prescription cards on the postnatal ward for all patients who had undergone emergency or elective CS over a 7‐day period in October to November 2018. Data on current staff opinions were collected from obstetricians, anaesthetists and midwives via an anonymous questionnaire.
Results
Data were collected on 27 patients, with the majority (93%) qualifying for enoxaparin prescription as per Trust guidelines. Four patients (16%) did not have LMWH prescribed or it was prescribed incorrectly. The majority (67%) of prophylactic LMWH was prescribed by anaesthetists. The staff survey was completed by 30 staff members. Overall, anaesthetists were thought to be responsible for LMWH prescription. Most midwives and obstetricians asked reported that the anaesthetists were responsible for this prescription (83% and 63% respectively). Interestingly, the anaesthetists were the most unsure about where the responsibility lay, showing an equal split in opinion.
Discussion
The project has raised some important questions within our department. We question whether the lack of assigning this role could lead to a higher chance of missed prescriptions. If one specialty is to be designated to this role, is it more appropriate for this to be done by members of the anaesthetic or obstetric team? As a result of this project, the anaesthetists have decided to adopt responsibility of VTE prescription during CS, although this will be done in conjunction with the obstetricians. Following a change to current departmental guidelines and education with regards to this change, we will repeat this project to evaluate the impact.
Robinson, E; Singh, Permendra. (2019). Post‐caesarean section venous thromboembolic prescription: do we need a defined prescriber role?. Anaesthesia. 74 (S4), 69