Aims and Objectives Up to 40%. That is the figure quoted by a Cochrane review regarding the incidence of VTE following immobilisation of the lower limbs without prophylactic medication (1) and highlights the significance of this aspect of injury management. Foundation and speciality trainees do not necessarily have a designated minor injuries placement, often being dealt with by specialist nursing colleagues, or in the urgent care centre. As a result of reduced exposure, junior doctors are less familiar with management of these issues, which can increase stress levels and reduce efficient management. A knock-on effect of this is reduced exposure to the other aspects involved, including the consideration of VTE prophylaxis in lower limb immobilisation, which should be considered as per NICE guidance (2), and can result in morbidity if not considered correctly.

Method and Design Questionnaires to the junior doctors in ED were sent out over a 6-month period to establish baseline knowledge regarding VTE consideration following injury, and specific management from the local trust guidance. A copy of the policy was emailed around, and a hard copy supplied to the equipment room where lower limb supports are stocked. PDSA cycles were completed.

Results and Conclusion Following a period of implementation, awareness of VTE application was reassessed, and noted to have dramatically improved (figure 1).

Although awareness improved, responses still showed a gap of knowledge regarding local trust policy and specific anticoagulation agents, perhaps as this differs from national guidance. LMWH is recommended by NICE whilst many trusts now use a DOAC, such as rivaroxaban. The next step would be to create a visual prompt on both the casting trolley and in the equipment cupboard, reminding of the agents used locally. Nationally, it would be advisable to get involved in studies on benefits and risks associated with types of anticoagulation - this will be the next stage of research.