Title : Adherence to anti-embolism stockings following elective knee and hip replacements for venous thromboembolism prophylaxis– A three loop quality improvement project
Abstract:
Orthopaedic patients are at higher risk of venous thromboembolism (VTE) during their inpatient stay due to reduced mobility. The National Institute for Health and Care Excellence recommends the use of anti-embolism stockings (AES) in combination with pharmacological interventions. A series of quality improvement projects were conducted.
Methods: Patients undergoing elective hip or knee arthroplasty were included in this audit. An initial audit demonstrated poor adherence to national guidelines so a proforma was created to acquire the following information: demographics, length of stay, use of VTE Risk Assessment tool, AES prescriptions, compliance with wearing AES and patient knowledge of VTE prophylaxis. Interventions included staff education followed by incorporating AES prescriptions as part of VTE prophylaxis on the electronic medical prescribing system.
Results: AES prescription improved slightly from 41% to 34% to 46% in the third cycle. Adherence to stocking use on both legs on day 1 improved from 12% to 34% in the second cycle and then decreased to 29% in the third cycle. On Day 3, 77% of patients had AES bilaterally which was higher than the second cycle (72%). Patient understanding of VTE prophylaxis was 92% in the second cycle and 89% in the third cycle.
Conclusion: We have demonstrated the importance of patient and staff understanding of the role of AES in VTE prophylaxis and the challenges of implementing 100% adherence. Ongoing VTE education is vital to improve patient safety and improve outcomes to prevent never events.
