Sequential Compression Device Compliance Research Articles

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

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.

Impact of a pharmacy technician on an interprofessional antithrombotic stewardship program at an academic medical center.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The need for monitoring and standardization of anticoagulation management has garnered the attention of national organizations, driving the implementation of antithrombotic stewardship programs (ASPs). Established ASPs have highlighted interdisciplinary collaboration between physicians, nurses, and pharmacists and demonstrated financial benefits and positive patient care outcomes. While pharmacy technicians are key members of the pharmacy profession, they are rarely utilized to expand clinical programs. The aim of this report is to describe the impact of adding a pharmacy technician to an ASP at an academic medical center. The departments of pharmacy and quality at West Virginia University Hospitals (WVUH) developed a business plan and financially justified an ASP. The ASP was implemented in January 2022 and consisted of 2 full-time clinical pharmacist specialists, 1 full-time clinical pharmacy technician, 2 full-time clinical nurse specialists, and 1 part-time physician medical director. The clinical pharmacy technician's primary role was to review patients' sequential compression device (SCD) compliance and newly started oral anticoagulants prior to discharge. The clinical nurse specialists educated patients newly started on oral anticoagulants within 24 hours of discharge and triaged any postdischarge medication access issues. The medical director provided high-level program oversight and acted as a clinical consultant on complex patient cases. In the first 6 months after the program's implementation, the clinical pharmacy technician made 174 recommendations to the clinical pharmacist specialists regarding discharge transitions of care and assessed SCD compliance in 246 patients. Of the 246 patients assessed, 217 patients (88%) were deemed to be noncompliant. The pharmacy department at WVUH successfully justified and implemented an interprofessional ASP at an academic medical center, which is the first ASP to date to incorporate a clinical pharmacy technician.

Sequential Compression Device Compliance for Venous Thromboembolism in High-Risk Trauma: A Quality Improvement Study.

Hospital-acquired, perioperative venous thromboembolism is a recognized patient safety indicator in the adult trauma patient population. Mechanical prophylaxis has been identified as a standard intervention to reduce the incidence of venous thromboembolism when prescribed along with anticoagulation or if anticoagulation is contraindicated in the surgical population. Adherence to consistent mechanical prophylaxis remains a nursing issue impacted by numerous factors in patient care. The purpose of this quality improvement project was to improve the compliance of sequential compression device utilization to decrease the hospital-acquired, perioperative venous thromboembolism rate in the adult hospitalized trauma patient population. A pre- and postintervention quality improvement approach utilized a nurse-led strategy to engage multidisciplinary team members to increase the consistency of sequential compression device utilization on patients within trauma units. The patient safety indicator rate per 1,000 for hospital-acquired, perioperative venous thromboembolism was monitored for improvement. The patient safety indicator rate per 1,000 for hospital-acquired, perioperative venous thromboembolism demonstrated a decline from 10.60 to 4.95 rate per 1,000 over 12 months. In the trauma units, sequential compression device compliance increased from an initial direct observation audit of only 12% to an average of 65% compliance rate during the last 16-week audits. We found that a multidisciplinary, nurse-driven approach in the trauma units was effective in improving the compliance of sequential compression device utilization and impacted the hospital acquired, perioperative venous thromboembolism rate in the adult trauma patient population.

Improving SCD compliance in trauma patients at Kings County Hospital Center: a quality improvement report

Venous thromboembolism (VTE) is the fourth most commonly reported complication in trauma patients. For these patients, thromboprophylaxis is a standard of care. Patient compliance with sequential compression devices (SCDs), a...

From Education to Practice: Incorporating Quality Improvement Projects Into a Baccalaureate Nursing Curriculum.

The accelerated pace of change in health care and the call for a radical transformation in prelicensure nursing education will require changes in baccalaureate nursing programs to ensure nurses are adequately prepared for practice. At one Midwestern university, academic nurse educators developed an innovative multilevel interprofessional and intradisciplinary education opportunity using a Lean Healthcare quality improvement (QI) process to improve systems, strengthen academic-practice partnerships, and bridge the education-to-practice gap. During one 16-week semester, one group of sophomore and junior clinical nursing students worked collaboratively with personnel at a local health care organization on a QI project on sequential compression devices. The students identified practice barriers related to sequential compression device compliance when medication prophylaxis was contraindicated. Using a Lean QI framework, the students developed and implemented a comprehensive, evidence-based venous thromboembolism prophylaxis policy, including tools and strategies for educating employees and patients.

Survey of Antepartum Women to Assess Barriers to Sequential Compression Device Compliance [30C

INTRODUCTION: Sequential compression device (SCD) is recommended for antepartum venous thromboembolism (VTE) prophylaxis. Based on a prior study by our group, women's compliance with SCD on antepartum floor is low. The objective of this study was to design and pilot test a patient survey to identify barriers to SCD use. METHODS: SCD survey was designed and assessed for validity and interpretation of each question by face-to-face cognitive interviews with providers and patients admitted to the antepartum floor and prescribed SCD. The survey was then administered to 50 pregnant women admitted to antepartum floor. Patient-reported understanding of SCD purpose, bother, and reasons for non-compliance were included in the survey. RESULTS: All women reported they understood the purpose of SCD. Across 12 categories of bothersome aspects of SCD, the average total bother score was 30 (range 12–60). The most common reasons women identified as why SCDs were not worn at all times were: 1) discomfort; 2) too hot/sweaty; and 3) they wake me up. The most common responses to what women believe would make SCD easier to use were to have a wireless/cordless device, lighter weight/cooler material, and to have a better availability of nurses to assist with SCD placement. CONCLUSION: In this pilot study we validated and pilot-tested a survey to identify self-reported barriers to SCD use among antepartum pregnant women. Self-identified barriers to use centered around discomfort and restrictive nature of the device. Women identified fixing these barriers as well as needing more assistance with the device as important in increasing its use.

Sequential compression device compliance in pregnant women requiring antepartum admission

Background A quality improvement study done at the Medical College of Wisconsin between 2014 and 2016 demonstrated that, at baseline, sequential compression devices (SCD) were ordered for 46.0% of admitted antepartum women. In response, provider education and a prechecked SCD order in the electronic antepartum admission order set were implemented. Objective To examine the effect of these interventions on SCD compliance during antepartum admissions. Study design This was a prospective observational study of antepartum women admitted for nondelivery indication for more than 24 hours, from June 2017 through March 2018, in a single tertiary center. The study was conducted a year after provider education and implementation of a prechecked order for SCD in the electronic antepartum admission order set. Women with an active venous thromboembolism (VTE) and those already receiving pharmacologic thromboprophylaxis were excluded. The primary outcome was the rate of SCD compliance, assessed both among obstetric providers and patients. SCD compliance for providers was defined as SCD order present in patient’s electronic medical record and documenting the presence of SCD in patient’s room. SCD compliance for patients was defined as documentation that the patient was wearing SCD that were turn on while in bed during morning study rounds. Results During the study period a total of 182 rounding encounters were documented for 76 women. SCD was ordered in 77.6% (59/76) of the admissions. Out of the 59 electronic orders for SCD, 45 orders (h 76.3%) were placed on hospital day 1 (and 42 orders had confirmation of SCD present in the room (71.2%)). SCD were in active use in 45.2% (19/42) of these women. When evaluating the daily course of the hospitalization (n = 182), SCD were ordered in 86.8% (158/182) of the encounters and present in the room in 72.2% (114/158) of the daily encounters. After excluding 10 women who were ambulatory at the time of rounding (n = 104), SCD were observed being used in 31.7% (33/104) of the nonambulatory women encounters with SCD ordered and present in the room. Conclusion A prechecked antepartum order set for SCD increased the rate of provider compliance with SCD. However, this increase did not result in high patient compliance with SCD among antepartum women requiring admission for longer than 24 hours. Condensation A prechecked order for SCD did not lead to high SCD compliance among admitted antepartum women.

Sequential Compression Device Compliance During Inpatient Antepartum Management [26I

INTRODUCTION: Recently, we implemented a quality improvement protocol where each antepartum admission order set included a pre-checked order for sequential compression device (SCD). The purpose of this study was to evaluate whether this change has led to increased compliance with SCD use during antepartum admission. METHODS: This was a prospective observational study including all pregnant women admitted for inpatient management in a single tertiary care center. The study was conducted between May 2017 and September 2017, a year after implementation of pre-checked order for SCD in the electronic antepartum admission order set. Prior to this implementation the rate of SCD order was 46.0%. Women receiving pharmacologic thromboprophylaxis were excluded. During daily morning rounds the study investigators assessed whether SCD was ordered, was in the room and whether it was in use. Woman was considered to be compliant if she was ambulating or in bed with SCD in use. RESULTS: During the study period a total of 356 rounding encounters were documented for 61 women. Mean length of stay was 6.51 days ± 7.6. 73.8% of admissions had a documented SCD order with 75.6% of these orders being placed on hospital day 1. Among women who had SCD ordered, 73.9% had the machine in the room and 33.3% were compliant with its use. Non-compliance increased with repeat rounding encounters (odds ratio of 1.35 per each rounding day, 95% CI 1.15 -1.54). CONCLUSION: Although pre-checked order set for SCD increased physician compliance with ordering SCD, patient compliance with SCD during antepartum admission was still low.

Compliance with mechanical venous thromboproembolism prophylaxis after cesarean delivery

Objective: Universal perioperative mechanical thromboprophylaxis is recommended for patients undergoing cesarean delivery because of increased risk for venous thromboembolism (VTE) associated with this mode of delivery. While research supports clinical benefits from this approach, other specialties have demonstrated suboptimal compliance with prophylaxis device use. The objective of this study was to review patient compliance with sequential compression devices (SCDs).Methods: This cross-sectional observational study utilized data from a prospective quality assurance analysis to evaluate demographic, medical and obstetrical factors associated with postoperative SCD compliance after cesarean delivery. Observations were performed before 7 a.m. on the first postoperative day, a time point when patients were unlikely to be fully ambulatory and would most benefit from device use. The reason for failure was documented in cases where the device was not being properly used.Results: Two hundred and ninety-three patients underwent cesarean delivery, had SCD compliance assessed and were included in the analysis. Twenty one percent of patients (n=60) were non-compliant with SCD use. Reasons for noncompliance included patient discomfort, machine malfunction and incorrect device use. Patients who were non-compliant had similar risk factors for thromboembolism compared to women who were compliant.Conclusion: Although SCD’s are effective in preventing thromboembolism, device use was suboptimal in this cohort of post-cesarean patients. These findings are similar to those from other fields. For institutions that rely primarily on mechanical thromboprophylaxis for obstetric patients, quality assurance and auditing of use may be necessary to ensure patients are receiving adequate prophylaxis. For post-cesarean patients with additional VTE risk factors, pharmacologic prophylaxis may be beneficial.

Sequential Compression Device Compliance in Postoperative Obstetrics and Gynecology Patients

Sequential Compression Device Compliance in Postoperative Obstetrics and Gynecology Patients

Sequential compression device compliance in postoperative obstetrics and gynecology patients.

To assess the association of patient and nursing education on sequential compression device compliance in patients who have undergone major obstetric or benign gynecologic procedures. We performed a prospective observational study on all English-speaking patients who underwent cesarean delivery or benign gynecologic surgery and were prescribed to wear sequential compression devices postoperatively at a university medical center. The 4-month study was divided into 1-month segments. The first month consisted of baseline observations of compliance. The second month was comprised of structured patient education, the third month involved nursing education, and the final month included both interventions. Observations were made twice daily. All educational interventions and observations were performed by two coauthors. A patient was noted to be compliant if she was ambulating, sitting, or lying in bed with sequential compression devices applied, tubing attached, and the machine powered on. A total of 859 observations was recorded for 228 patients. The number of hospitalization days ranged from 1 to 13 (mean 2.40 days, median 2 days). There was no difference in compliance among the months with 141 of 230 (61.3%), 106 of 194 (54.6%), 155 of 277 (56.0%), and 95 of 158 (60.1%) compliance for each consecutive month (P=.44). Noncompliance increased with each successive postoperative day (odds ratio 1.18 per day, 95% confidence interval 1.07-1.30). The most common patient-stated reason for noncompliance was "the nurse said I don't need them anymore" (82/362 observations [22.6%]). Overall, cesarean delivery was associated with the lowest rate of compliance when compared with gynecologic surgeries (272/519 [52.4%] compared with 225/340 [66.2%], P<.001). Compliance with postoperative use of sequential compression devices is approximately 58% and did not improve with patient or nursing educational interventions. III.

Sequential Compression Device Compliance in Post-Operative Obstetric and Gynecology Patients

Sequential Compression Device Compliance in Post-Operative Obstetric and Gynecology Patients

A Prospective Study of Nurse and Patient Education on Compliance with Sequential Compression Devices

Sequential compression devices (SCD) have become the most common form of prophylaxis against the formation of deep venous thrombosis (DVT) among surgical patients. However, compliance with SCD has traditionally been poor. The aim of this study was to assess the affect of patient and nurse education by surgeons on SCD compliance. This was a prospective study involving a single teaching hospital. Compliance was checked twice daily. The main outcomes were compliance rates with SCD use before and after nurse and patient education. Nurses were not aware of the study. Surgical floors had a history of resident and attending interactions regarding SCD, whereas nonsurgical floors did not. A handout that emphasized SCD importance was also given to patients on surgical units. Before education, surgical units had a compliance rate of 61.5 per cent, whereas nonsurgical units had a 48 per cent compliance rate. This difference was significant (P = 0.014). After nursing and patient education on the busiest surgical floor, compliance rates on the surgical ward increased to 65 per cent, a difference that was not of statistical significance (P = 0.515). A nursing unit's daily experience is the most important factor in their compliance rates with SCD use. Focused nursing lectures and patient education may have incremental value.