Becs Walsh

Yes; omit if surgery is on the same day. That is the plan....

I have never heard of them, sorry!

Ah Sue - trying to tame the untameable beast. Decision to hold is sometimes made by the medic, sometimes by the nurse. Sometimes a reason is documented, sometimes not. In our opinion omission is only indicated pre biopsy/ ERCP/ surgery if it is imminent, as in within the next 6 hours (unless poor renal function). Like you, and no doubt many others, there is indecision around surgery, doses omitted the evening before, surgery postponed until the following day...... and repeat. We are moving our default giving time for once-daily prophylactic LMWH to 2pm; I hope this will support appropriate administration pre-op, though will no doubt cause problems in other areas?

We were also fortunate to get our Coroners on board in the early days. They didn't get it first but I think were impressed that we were trying to find cases where we could have done better & improve our own practice, rather than wait for them to shout at us. At first we had to trawl through their entire database to identify where PE was the cause of death, which was traumatising to say the least. Now they send us a spreadsheet with relevant info. The data is always at least 3 months post-identification of cause of death, which can in turn be a long time since the date of death, so I am sure you could assure your Coroner that you won't know anything earlier than anyone else @sue bacon As ever so much of this was relational - there was a Coroners officer who was very supportive of what we were doing and we built a good working relationship with him. Good luck Sue

They give a stat dose to lots of breast/ plastic patients here but this is post-op not pre (and equally baffling to me).

We have seen some of this practice here - omitting the night before ERCP or biopsies and sometimes the evening after. I can't think of a good reason for omitting any prophylactic doses around the time of ERCP and the practice has been challenged.

And in terms of covid guideline, ours still says what the NICE guideline says, in practice I think the majority get standard prophylaxis, not extended past hospitalisation.

Not specifically for Covid patients but we are seeing an increase in use of fonda for thromboprophylaxis and treatment of VTE. I'm not confident that the decision to prescribe instead of LMWH is a particularly well-informed one, either on the part of patients or medics/ nurses/ midwives. We have one patient on it long-term for VTE, I remember we needed to do an IFR for the CCG (as was) to agree to pay for it.

We use eGFR for prophylaxis and crcl for treatment. The rationale being that eGFR is a "good enough" estimate of renal function and, since virtually every patient in the hospital is on it, asking a doctor to do the crcl calculation for every patient is unrealistic. Where it is more important to have a better idea of renal function - when giving treatment doses - we use crcl.. Treatment doses are ordered from pharmacy (mostly) so there is a check available on the calculation, as well as the dosing etc. It's worth remembering that these are estimates of renal function and skewed in all directions by extremes of age and body weight. The only way to truly assess renal function is to collect pee for 24 hours and analyse it which, believe it or not, was practice when I started out in oncology. And I'm not even that old. Becs

Hi Simon. If you go to the Communities section from the homepage and then select "Patient safety in health and care" then "high risk areas"; VSN should be listed there. Other members have had issues accessing so if you find that VSN isn't there as an option then let me know by email ([email protected]). The "cheat sheet" is attached with screenshots which explain the above, and ways of sharing resources. Becs How to use the hub - cheatsheet for VSN members (1).pdf

See Alex's comment on the chemical thromboprophylaxis thread - they have just started using apixaban 2.5mg BD in this context.