327 Sustained Improvement in Compliance With Use of Sequential Compression Devices in a Neurosurgery Patient Population of a Safety-Net Hospital

Abstract

INTRODUCTION: Sequential Compression Devices (SCDs) are utilized in perioperative patients given increased risks of deep venous thrombosis from mobility reductions and post-operative inflammatory responses. Additionally, mechanical prophylaxis is crucial in patients where chemical prophylaxis is contraindicated. Previous work has found SCD compliance far less than expected. METHODS: Across a 9-month period (August-April), we tracked which neurosurgical patients in stepdown units had SCDs on and properly functioning. When not on or properly functioning, we documented the missing element. Compliance was calculated daily as the percentage of patients who were SCD compliant out of all patients with SCD orders, then averaged over the month, for each month. Most common barriers to compliance were identified. Together with nursing management, we designed and implemented a best practice alert to facilitate nursing education and supply chain management, at month 3. The impact was tracked over the next six months, with a 4-months break from November-February. RESULTS: Compliance averaged 19.7% (n = 95) during August, and 38.4% (n = 131) in September. After implementation of the best practice nursing alert and supply chain upgrades, compliance was 48.8% (n = 150) in October, 41.2% (n = 104) in March, and 45.9% (n = 76) in April. Residual barriers to compliance included patient behavior and equipment issues. Compliance was significantly increased from baseline in August to October (z = 5.042). The significant difference was sustained through March (z = 3.402) and April (z = 3.730). CONCLUSIONS: While initial improvement was attributed to a Hawthorne effect, implementation of the best practice nursing alert likely facilitated the sustained improvement in SCD compliance despite the break in surveillance. SCD compliance nonetheless remained below 50%. Further study is warranted to address the remaining barriers, such as improving patient engagement and minimizing equipment malfunction.