Title : Improving VTE prophylaxis compliance in burn patients
Abstract:
Patients with burn injuries are at increased risk for venous thromboembolism (VTE) and often require higher doses of prophylactic anticoagulation. Despite this, there is no universal guideline for VTE prophylaxis in this population, leading to significant practice variation. At the Royal Brisbane and Women's Hospital (RBWH) Burns Centre, local guidelines recommend twice-daily dosing of Enoxaparin for high-risk patients, with dose adjustments based on body weight. However, adherence to these guidelines has been inconsistent.
A retrospective audit of patient records from January 1 to March 1, 2025, was conducted to evaluate current practice. Of 57 charts reviewed, 42 met inclusion criteria. While 95.2% of patients received some form of VTE prophylaxis, only 10.5% were prescribed the recommended twice-daily dosing. Notably, none of the six patients weighing over 100 kg received appropriately adjusted doses, highlighting substantial non-compliance with local protocols.
In response, a revised VTE prophylaxis guideline was developed in collaboration with the Head of Department and Ward Pharmacist. This updated protocol included weight- and BMI-based dosing adjustments and recommendations for anti-Xa level monitoring. It was disseminated to staff via an educational session and a visual summary poster on March 9, 2025. A re-audit conducted one month post-implementation demonstrated 100% compliance (31/31 patients).
This quality improvement initiative successfully standardized VTE prophylaxis practices in burn patients, significantly improving adherence to local guidelines and promoting safer, evidence-based care.
