Standards › Standard 1 › Forms
Form · CLN-FRM-007 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 1.7
Purpose
Records the clot risk assessment on admission and before surgery, and the prophylaxis given.
How to complete
- Complete on admission and before each surgical procedure.
- Record the prophylaxis prescribed.
- Record the reason if none is given.
Checks
| Check | Entry |
|---|---|
| Risk assessed on admission | Yes |
| Risk assessed before surgery | Yes or N/A |
| Prophylaxis prescribed (drug or mechanical) | Yes or reason |
| Prophylaxis given as prescribed | Yes |
| Assessed by and date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on NICE guideline NG89 on venous thromboembolism (2018). |
| E-006 | ASF Policy Framework v1.2. Adapted. |
| E-009 | ASF Expert Committee consensus. |
Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version | set Expert Committee approval |
E-learning for this document
- Patient Rights and Responsibilities (A-01)
- Patient Identification, Informed Consent and Patient Rights (T-07)
- Care & Treatment: Clinical Standards for Accreditation (H-04)
- Medication Safety: Operating SOP-MED-01 End to End (T-08)
References
- Accréditation Sans Frontières (2026). ASF Policy Framework v1.2. (E-006)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)