Letters Clinical audits

Paper or patient safety?

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4175 (Published 12 October 2009) Cite this as: BMJ 2009;339:b4175
  1. Belinda Sandler, SHO, cardiology1,
  2. John M Hounsell, registrar, cardiology1,
  3. Thomas Semple, house officer, cardiology1
  1. 1Lister Hospital, Stevenage SG1 4AB
  1. b.sandler{at}doctors.net.uk

    Guidelines on preventing venothromboembolism issued by the Department of Health in 2007 included documented mandatory risk assessment for every hospital patient. In our district general hospital all adult medical admissions have undergone such a process since April 2009. A risk assessment proforma is completed and the patient is then assigned a category—not at risk or requiring low molecular weight heparin or thromboembolus deterrent stockings, or both.

    Recently the completion of this proforma has been audited locally. Favourable outcomes included full and early completion of the paperwork but the prescription of prophylaxis, or indeed its effective and timely administration, was not evaluated. Thus a patient could have a perfectly documented risk assessment but be receiving no clinical benefits. Does this equate to patient safety or good clinical practice?

    Both risk management and audit are important but can compromise time spent with patients. If they result in improved clinical practice and patient care in the long term the sacrifice may be worth while.1 However, if they result only in better completion of time consuming paper work these strategies need to be re-evaluated.


    Cite this as: BMJ 2009;339:b4175


    • Competing interests: None declared.


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