Aim:
To assess whether the timing of enoxaparin administration for venous thromboembolism(VTE) prophylaxis after caesarean section aligns with hospital protocols and international clinical guidelines.
Methods:
A retrospective audit was conducted in the obstetrics department of the Northern Hospital over 1month(1November-30November2024). Medical records of115 post-caesarean patients were reviewed. Data collected included time of neuraxial manipulation, type of anaesthesia, timing of first enoxaparin dose, and documentation of VTE risk factors. Compliance was assessed against local thromboprophylaxis protocols (The Northern Hospital and Queensland Pregnancy and Puerperium Guidelines) and international recommendations (New York School of Regional Anaesthesia and SOMANZ).
Results:
Of the 115 patients reviewed, 96 (83.5%) received enoxaparin postoperatively. Only 9 (9.4%) of those received the first dose within the recommended 5–7hour window. One patient (1.0%) received it too early (<4 hours), posing a bleeding risk. Most doses were administered later than recommended: 34 (35.4%) between 7–10hours, 42 (43.8%) between 10–24 hours, and 11 (11.5%) after 24 hours, potentially reducing prophylactic effectiveness. Additionally, 3 patients (2.6%) were given enoxaparin without clinical indication, while 6 (5.2%) did not receive it despite indication.
Conclusions:
Over 90% of patients received enoxaparin outside the recommended time, potentially increasing the risk of bleeding or VTE. Contributing factors included limited staff education and a new electronic VTE risk assessment form. Educational initiatives are being implemented, and the electronic tool is being revised to improve clarity, accessibility, and usability. A follow-up audit is planned to evaluate the impact of these interventions on clinical practice and patient safety.