Abstract
Background Venous thromboembolism (VTE) is an important and potentially preventable cause of morbidity and mortality in hospitalised patients. It is a significant, international patient safety issue affecting medical, surgical and mental health in-patients. There is a paucity of published evidence on the incidence of VTE, and the role of VTE risk-assessment and prophylaxis, in mental healthcare settings. Epidemiological evidence indicates that antipsychotic medications are an independent risk factor for VTE. Objective To explore healthcare practitioners’ experiences and perspectives regarding VTE prophylaxis for in-patients in mental health services in Ireland. Setting This study was conducted in two national teaching hospitals in Dublin, Ireland. Method This experiential, qualitative study was conducted using face-to-face, semi-structured interviews. Purposive sampling was used to allow strategic selection of participants from the pharmacy, medical and nursing disciplines. Data was analysed using inductive thematic analysis. Consolidated criteria for reporting qualitative studies guidelines were used as a reporting framework. Main outcome measure Participants’ views on VTE prophylaxis for mental health in-patients. Results Five key themes were derived: risk factors in mental health, attitudes to risk-assessment, challenges with VTE prophylaxis, lack of awareness, and lack of evidence in mental health. Conclusion The results indicate considerable diversities in perceived risk of VTE, and in experiences with VTE risk-assessment and prophylaxis. VTE risk was considered in practice specifically for immobile, older adults and eating disorder patients on bed rest. Specific research is required to address this area of clinical uncertainty in mental health.
Similar content being viewed by others
References
National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for hospitalised patients. Clin Guidel. 2010;92 (updated June 2015). https://www.nice.org.uk/guidance/cg92/resources/venous-thromboembolism-reducing-the-risk-for-patients-in-hospital-pdf-975745995973. Accessed 11 Sept 2017.
Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34:2363–71.
Scottish Intercollegiate Guidelines Network. Prevention and management of venous thromboembolism. Natl Clin Guidel. 2010;122 (Updated October 2014). http://www.sign.ac.uk/assets/sign122.pdf. Accessed 11 Sept 2017.
Hippsley-Cox J, Coupland C. Development and validation of risk prediction algorithm (QThrombosis) to estimate future risk of venous thromboembolism: prospective cohort study. BMJ. 2011;343:d4656.
Department of Health UK. Risk assessment for VTE. 2010. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113355.pdf. Accessed 11 Sept 2017.
Barbui C, Conti V, Cipriani A. Antipsychotic drug exposure and risk of venous thromboembolism: a systematic review and meta-analysis of observational studies. Drug Saf. 2014;37:79–90.
Masopust J, Maly R, Valis M. risk of venous thromboembolism during treatment with antipsychotic agents. Psychiatry Clin Neurosci. 2012;66:541–52.
Zhang R, Dong L, Shao F, Tan X, Ying K. Antipsychotics and venous thromboembolism risk: a meta-analysis. Pharmacopsychiatry. 2011;44:183–8.
Parker C, Coupland C, Hippisley-Cox J. Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ. 2010;341:c4245.
Hagg S, Bate A, Stahl M, Spigset O. Associations between venous thromboembolism and antipsychotics. A study of the WHO database of adverse drug reactions. Drug Saf. 2008;31(8):685–94.
Delluc A, Montavon S, Canceil O, Carpentier M, Nowak E, Mercier B, et al. Incidence of venous thromboembolism in psychiatric units. Thromb Res. 2012;130(6):e283–8. https://doi.org/10.1016/j.thromres.2012.10.002 (Epub 2012 Oct 23).
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32 item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57.
Braun V, Clarke V. Successful qualitative research, a practical guide for beginners. London: SAGE Publications Ltd; 2013.
Cowen P, Harrison P, Burns T. Shorter oxford textbook of psychiatry. 6th ed. Oxford: Oxford University Press; 2012.
Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, et al. A risk assessment model for the identification of hospitalised medical patients at risk for venous thromboembolism: the Padua prediction score. J Thromb Haemost. 2010;8(11):2450–7. https://doi.org/10.1111/j.1538-7836.2010.04044.x.
Jenkinson J. A critical analysis of VTE prophylaxis in psychiatric patients. Poster presentation. Royal College of Psychiatrists’ International Congress; 2012.
Royal College of Psychiatrists. Whole-person care: from rhetoric to reality. Achieving parity between mental health and physical health. Occasional paper OP88. 2013. http://www.rcpsych.ac.uk/files/pdfversion/OP88xx.pdf. Accessed 11 Sept 2017.
McFarland L, Murray E, Harrison S, Heneghan C, Ward A, Fitzmaurice D, et al. Current practice of venous thromboembolism prevention in acute trusts: a qualitative study. BMJ Open. 2014;4(6):e005074.
Al-Taiar H, Nathoo A, Shaheed S. Physical health and VTE risk assessment audit-mental health division (re-audit). 2013. https://www.nice.org.uk/sharedlearning/physical-health-vte-risk-assessment-audit-mental-health-division-re-audit. Accessed 11 Sept 2017.
Croxford A, Clare A, Mc Curdy K. Introduction of venous thromboembolism prophylaxis protocol for older adult psychiatric patients. BMJ Qual Improv Rep. 2015. https://doi.org/10.1136/bmjquality.u205852.w3226.
Patel R. Venous thromboembolism prophylaxis in mental healthcare: do the benefits outweigh the risks? BJ Psych Bull. 2015;39:61–4.
Acknowledgements
We acknowledge the contribution of Dr Consilia Walsh, St Vincent’s University Hospital, Dublin to the participant selection and recruitment process. We acknowledge the contribution of participants from both Saint John of God Hospital, and St Vincent’s University Hospital, Dublin.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
None.
Conflicts of interest
No conflict of interest declared for each author and contributor.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Purcell, A., Clarke, M. & Maidment, I. Venous thromboembolism prophylaxis in mental health in-patient services: a qualitative study. Int J Clin Pharm 40, 543–549 (2018). https://doi.org/10.1007/s11096-018-0599-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-018-0599-7