We read with a great interest your recent article by Essam et al. on venous thromboembolism mortality and the use of thromboprophylaxis in a large district hospital in Jeddah. We conducted a one-day spot-check study on the use of heparin thromboprophylactic interventions in the acute medical wards. All in-patients were risk-assessed for thrombosis and their recommended prophylactic intervention as per their risk score was compared with the treating team prescribed intervention. Of 81 acutely admitted medical patients with a mean age of 66 years, four were on therapeutic anticoagulation, three had no indication for heparin thromboprophylaxis, and 10 had a contraindication for heparin therapy. Of the remaining 64 patients, four (6.3%) were not offered the indicated prophylaxis and 30 (46.8%) were on a sub-therapeutic heparin regime as per the AHRQ guidelines. Our findings corroborate with the above and other studies on the underuse of this important patient safety intervention. As per the institute of medicine recommendations, a system redesign intervention is paramount to resolve such quality issues. The department of medicine has since and through its guidelines committee embarked on the following implementation strategies to improve the use of thromboprophylaxis. The above findings were brought to the attention of medical staff in several departmental meetings, a risk stratification score and guidance on deep venous thrombosis prophylaxis was included in the newly implemented Computerized Physician Order Entry interface, a daily deep venous thrombosis (DVT) prophylaxis monitoring on admitted patients became a compulsory activity by the guidelines committee's coordinator and a nursing staff educational exercise on DVT prophylaxis was started. The aim of the latter is to get nursing staff proactive involvement. We plan to include a DVT risk scoring exercise as another essential Vital Sign assessment by nursing staff. The outcome of these interventions is planned to assess their impact.