Assessment of risk of venous thromboembolism (VTE) when prescribing combined hormonal contraceptives

Through its review of recorded patient safety events, the National Patient Safety Team identified an issue where a patient sadly died after no assessment of lifestyle factors was made during a remote consultation, before being prescribed combined hormonal contraception (CHC).

When taking CHC there is a small risk of VTE. This risk is increased in patients with additional VTE risk factors such as older age, obesity, surgery, personal history of thromboembolism, smoking, and prolonged immobilisation, including as a result of long duration travel etc. Prescribers of CHC should use a checklist during a CHC consultation to assess if patients may be at increased risk.

The report reviewed by the team outlined that, as part of a telephone consultation, there was no record of assessment of lifestyle factors prior to prescribing CHC.  The patient subsequently developed VTE and died.

The team highlighted this concern as part of General Medical Council’s (GMC) call for evidence on remote consultations and prescribing. A request was made that the GMC guidance on prescribing and managing medicines and devices, includes a process for gathering information on lifestyle factors that may increase certain risks of serious side effects of medicines, as part of an adequate history taking process.

he team also liaised with the Faculty of Sexual and Reproductive Healthcare (FSRH) to improve signposting within the FSRH Clinical guideline for combined hormonal contraception. This will support healthcare practitioners to ensure users of combined hormonal contraceptives receive adequate information regarding VTE risk, to allow them to make an informed decision about using CHC, and to minimise associated health risks.

About our patient safety review and response work

The recording and central collection of patient safety events to support learning and improvement is fundamental to improving patient safety across all parts of NHS healthcare. The National Patient Safety Team identify new or under recognised patient safety risks, which are often not obvious at a local level. It does this through its core work to review patients safety events recorded on national systems, such as the National Reporting and Learning System (NRLS), the new Learn from Patient Safety Events service (LFPSE), and other sources.

In response to any newly identified risks, we develop advice and guidance, such as National Patient Safety Alerts, or work directly with partners as in the example above, to support providers across the NHS to take the necessary action to keep patients safe.

You can find out more about our processes for identifying new and under recognised patient safety issues on our using patient safety events data to keep patients safe and reviewing patient safety events and developing advice and guidance web pages.

You can also find more case studies providing examples of this work on our case study page.