A Regional Audit on Venous Thromboembolism (VTE) Prophylaxis Compliance and Cultural Considerations in Prescribing Porcine-Derived Low-Molecular-Weight Heparins

BACKGROUND: Hospital-acquired venous thromboembolism (VTE) remains a leading cause of preventable mortality in the NHS. NICE guidelines (NG89) mandate timely risk assessment and prophylaxis, yet practice varies widely. Many low-molecular-weight heparins (LMWHs), such as tinzaparin, are porcine-derived, posing ethical challenges for patients with specific dietary or religious beliefs. OBJECTIVE: The objective of this study is to evaluate adherence to NICE NG89 guidelines on VTE prophylaxis across two hospitals, with a particular focus on culturally sensitive prescribing. This audit also assessed clinician awareness of LMWH origins and explored patient preferences around dietary compliance. The impact of targeted interventions was measured across two audit cycles. METHOD: A prospective two-cycle audit was conducted at two NHS hospitals in North East England, The James Cook University Hospital (JCUH) and University Hospital North Tees (UHNT), between March 2024 and January 2025. Patients with dietary requirements were identified via catering records and surveyed. A doctor questionnaire assessed awareness and counselling practice. Interventions included staff education, posters, prescribing alerts, and community outreach. RESULTS: Cycle one included 76 patients. Cycle two included 61 patients. VTE risk assessment improved by 14% at UHNT; JCUH maintained 100% compliance. However, timely prophylaxis fell in UHNT, with 80% receiving it late. Documentation and discussions regarding VTE and dietary compliance improved but remained suboptimal. Leaflet distribution rose by 10% at JCUH but was absent at UHNT. Notably, 98% (n = 137) of patients prioritised medication aligned with their beliefs, and nearly half would decline porcine-derived prophylaxis even if it prevented serious illness. Clinician questionnaire data showed 64% (n = 50) were unaware that LMWHs are animal-derived, and 94% (n = 50) did not inform patients, citing time pressures and limited knowledge. CONCLUSION: While guideline compliance improved following intervention, particularly for risk assessments and documentation, major gaps remain in patient communication and dietary-informed prescribing. Most patients expected transparency and alternatives to porcine-based medications. Future efforts must embed dietary screening into routine prescribing and strengthen shared decision-making through structured education and culturally competent communication strategies.