Authors (including presenting author) :
Chan PS, Wong E, Lo G, Sze-To CL, Chan SY, Chan SM
Affiliation :
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
• Venous Thromboembolism (VTE)
Keyword 2: :
• Oncology inpatients
Keyword 3: :
• Integrated Care Programme (ICP)
Keyword 4: :
• Screening & Prophylaxis
Keyword 5: :
• Plan-Do-Check-Act (PDCA) cycle
Introduction :
Venous Thromboembolism (VTE) is the leading thrombotic complication in oncology and the non-cancer cause of mortality in this population. Hospitalisation elevates VTE risk, necessitating systematic assessment and prevention. In our department, VTE prevention originated as a nurse-initiated programme since 2022, focusing on mechanical prophylaxis for deep vein thrombosis, including heels and toes exercise, mobilization and gradual compression socking application. Recognising that oncology patients require more than general cluster guidelines, the programme was reviewed and subsequently evolved into a comprehensive, multidisciplinary VTE screening and prophylaxis workflow, integrating both mechanical and pharmacological prophylaxis, implemented in June 2024. This integrated care programme (ICP) employs an ongoing Plan-Do-Check-Act (PDCA) cycle aimed at bridging the gap between nursing surveillance and medical interventions.
Objectives :
To evaluate the effectiveness of the oncology specific ICP to enhance the multidisciplinary care for VTE prevention, and review on staff compliance.
Methodology :
A retrospective audit was conducted on all inpatients in Oncology wards on 4 March 2025. Patient records were reviewed from admission or transfer-in until discharge. Nursing adherence was measured by the completion rate of risk screenings, while scoring accuracy was verified by auditing the risk factor identification and score derivation. Medical compliance was evaluated based on the timeliness and suitability of prophylaxis in high-risk patients according to the departmental algorithm. In addition, the occurrence of VTE during admission was reviewed as a clinical outcome.
Result & Outcome :
Fifty-five patients were audited. All patients (100%) received nursing risk assessments, with no scoring errors identified. Fifty patients were identified as high risk, with 98% received appropriate nursing care. Amongst the high-risk patients, 96% underwent timely medical assessment. Thirty-nine patients met exclusion criteria for pharmacological prophylaxis. Seven patients had documented contraindications to pharmacological prophylaxis, while two patients with no contraindication declined prophylaxis, and were correctly managed with mechanical intervention. No patients developed VTE during their admission. Overall, 93% of patients received appropriate VTE screening and prevention. This multi-year, nurse-led initiative, now a multidisciplinary programme, verified the high level of screening accuracy, and enhanced clinical safety for oncology inpatients. The tailored approach addresses the complex needs and elevated risks in this population, demonstrating the value of continuous quality improvement in clinical practice.
