What is it about?

It is recommended that patients having planned or emergency surgery related to colorectal cancer should be discharged with 28 days of clot-preventing medication, if not already on them. The frequent rotation of junior doctors is a reason for variations in prescribing practices. This quality improvement project describes how this variation was identified and remedied using six interventions involving all health professionals involved in post-operative care.

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Why is it important?

The complications arising from blood clots following major surgery can be serious, causing irreversible harm or in some cases death. It is important that patients have their risk assessed at the time of discharge, and the appropriate medication prescribed. In cases where patients are not already on blood thinning medication, it is recommended they leave with 28 days of self-injecting medication to prevent clot formation. By identifying the frequent rotation of junior doctors as a cause of lapses in prescribing practice, we hope that other institutions will use our suggested interventions to asses their practice. It is the duty of all health care professionals to liaise and communicate efficiently, but the frequent movement of staff causes messages to be lost. A robust system is therefore required to prevent lapses in prescribing practice.


Advances in surgery and therapeutics over the last two decades have contributed to significant improvement in outcomes for patients with bowel cancer. Blood clots before, during and after cancer-related surgery remain a serious, but preventable, medical condition. Therefore, it is important that health professionals and patients both work together to build on these marginal gains to improve overall outcomes. This study highlights the issues with frequent rotation of junior doctors (in this case) resulting in peaks and troughs in consistently achieving the 100% standards for prescribing practices. Using six interventions involving all health professionals involved in the post-operative care of patients, there is a robust system in place. We hope our results and our interventions inspire other individuals and institutions to consider reaping this marginal gains.

Adarsh Shah
University of Aberdeen

Read the Original

This page is a summary of: Improving prescribing of extended prophylaxis for venous thromboembolism at discharge in patients who underwent surgery for colorectal cancer, British Journal of Hospital Medicine, December 2020, Mark Allen Group,
DOI: 10.12968/hmed.2020.0405.
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