Background <p>Venous thromboembolism is a potentially life-threatening condition, with patients having active malignancy at a 12-fold higher risk. Hospital-acquired VTE contributes to mortality, morbidity, and prolonged hospitalization. The 2024 British Society for Haematology guidelines recommend VTE risk assessment and prophylaxis within 24 h of admission. This audit evaluated adherence to these guidelines among oncology inpatients, aiming to identify gaps and opportunities for standardizing VTE management.</p> Methods <p>A retrospective audit was conducted on 99 oncology inpatients. Electronic records, admission documentation, and drug charts were reviewed for VTE risk assessment completion and timing, prescription and appropriateness of pharmacological prophylaxis, 24-h reassessment, and adherence to cancer-associated thrombosis treatment standards. Patients with documented contraindications to anticoagulation were excluded from adherence analyses. Data were compared with BSH 2024 recommendations, and frequencies and percentages were calculated.</p> Results <p>VTE risk assessment was documented in 64.6% (<i>n</i> = 64) of patients, while 35.4% (<i>n</i> = 35) had no recorded assessment or reassessment. Among assessed patients, 57.8% (<i>n</i> = 37) were high risk, 28.1% (<i>n</i> = 18) low risk, and 14.1% (<i>n</i> = 9) high bleeding risk. Pharmacological prophylaxis was prescribed in 71.7% (<i>n</i> = 71) of patients, initiated within 14 h in 36.6% (<i>n</i> = 26), and appropriately selected in 88.5% (<i>n</i> = 23) of those receiving timely prophylaxis. Reassessment within 24 h occurred in 12.1% (<i>n</i> = 12) of patients. Hospital-acquired thrombosis was identified in 6.1% (<i>n</i> = 6) of patients, with prophylaxis adherence varying across services: 71.0% (<i>n</i> = 71) in medical oncology, 26.2% (<i>n</i> = 26) in surgical oncology, and 11.1% (<i>n</i> = 11) in myeloma pathways. Catheter-related thrombosis prevention was documented in 4.0% (<i>n</i> = 4). For CAT management, 69.6% (<i>n</i> = 69) received anticoagulation during the first six months and continued beyond six months if the malignancy remained active. Recurrent VTE occurred in 22.2% (<i>n</i> = 22) of patients receiving complete treatment.</p> Conclusion <p>Clinical practice in this oncology department largely aligns with BSH 2024 recommendations; however, documentation is inconsistent and incomplete. Standardized electronic templates, mandatory assessment fields, clarified myeloma pathways, and targeted staff education may improve adherence. A follow-up re-audit is recommended to evaluate progress and reinforce guideline implementation.</p>