PB1483 - Right needle, right patient, right time? A national flash-mob audit of thromboprophylaxis of cancer inpatients receiving palliative care.

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

AC

Alice Crabtree

Specialist Registrar
Velindre Cancer Centre
Cardiff, Wales, United Kingdom
EK

Emily Kavanagh

Consultant Palliative Medicine
North Tees Hospital & Alice House Hospice
Hartlepool, England, United Kingdom
CC

Charlotte Chamberlain

Consultant Palliative Medicine
Bristol Medical School
Bristol, England, United Kingdom
DW

Donna Wakefield

Consultant Palliative Medicine
North Tees Hospital & Alice House Hospice
Hartlepool, England, United Kingdom
RD

Rhian Daniel

Professor Statistics
Cardiff University
Cardiff, Wales, United Kingdom
GS

Guy Schofield

Consultant Palliative Medicine
Bristol Medical School
Bristol, England, United Kingdom
AS

Angela Star

Consultant Palliative Medicine
Sheffield Teaching Hospitals
Sheffield, England, United Kingdom
SY

Sarah Yardley

Professor Palliative Medicine
University College Hospital
London, England, United Kingdom
IW

Imogen Whyte

Consultant Palliative Medicine
University College Hospital
London, England, United Kingdom
CC

Christina Chu

Consultant Palliative Medicine
Saint Francis Hospice
Romford, England, United Kingdom
HB

Hannah Billett

Consultant Palliative Medicine
Northumbria NHS Trust
Northumbria, England, United Kingdom

Presenting Author(s)

Simon I R Noble, MD (he/him/his)

Professor Supportive and Palliative Medicine
Cardiff University
Newport, Wales, United Kingdom

Background: United Kingdom health policy dictates that all hospitalised patients are risk assessed and receive thromboprophylaxis, where appropriate. Patients with advanced cancer receiving palliative care are highly prothrombotic, yet research suggests palliative care physicians are reluctant to prescribe pharmacological thromboprophylaxis for them. Thromboprophylaxis prescribing in this patient group remains unknown.

Aims: To explore thromboprophylaxis practice of cancer inpatients receiving palliative care through the audit of compliance with UK minimum standards set by the National Institute for Health Care and Excellence.

Methods: A one day “flash-mob” audit of cancer inpatients, receiving palliative care, conducted across 52 hospitals and 67 UK HSPCUs. Clinical notes were reviewed for compliance with UK minimum standards that inpatients should:
• Have a documented thrombosis risk assessment
• Where appropriate, receive thromboprophylaxis
Appropriate management was defined as provision of thromboprophylaxis in at risk patients or withholding thromboprophylaxis in the presence of contraindications.

Results: Data were collected for 1125 patients. Appropriate management was observed in 90% of hospital and 90% HSPCUs. Documented risk assessment was only found in 79% and 71% of patient notes respectively. Pharmacological thromboprophylaxis was contraindicated in 88% of HSPCU patients due to bleeding risk or receiving end of life care. Twenty-four percent of patients in hospital had contraindications due to receiving end of life care, bleeding risk and thrombocytopenia.
After adjusting for key patient characteristics (AKPS, age, gender, location of primary cancer, comorbidities and bleed history) the risk difference between recruitment sites was estimated to be 0.33 (95% Confidence Interval 0.28-0.39), suggesting patients are 33% more likely to receive appropriate thromboprophylaxis in hospital than HSPCU.

Conclusion(s): Overall, thromboprophylaxis of palliative care patients adhered to clinical guidelines in hospital and HSPCU settings. In both settings, documentation of risk assessments were recorded less frequently. Patients in HSPU settings, compared to hospital settings, had more contraindications to pharmacological thromboprophylaxis.