S. A. Windermere1,2, J. Joseph1, D. Cole1, O. Vazquez1, B. Fazzone1, E. Vanzant1 1University Of Florida, Trauma And Acute Care Surgery, Gainesville, FL, USA 2Boston University, Neurosurgery, Boston, MA, USA
Introduction: Deep vein thromboses are a common cause of death in hospitalized trauma patients and the 2nd leading complication in post-surgical patients. Sequential Compression Devices (SCDs) are implemented to reduce this serious complication in various surgical populations. Our study aims to compare identified barriers to SCD compliance at two institutions: 1) a surgical stepdown population at Boston Medical Center in Boston, Massachusetts (BMC), and 2) a larger surgical floor population at University of Florida Shands of Gainesville, Florida (UF) and determine if compliance varies with an intervention. The results of our study are valuable towards increasing SCD compliance to support the recovery of inpatients.
Methods: For the first part of our study, we tracked the use of SCDs amongst neurosurgical patients in stepdown units at BMC. Across nine months, we assessed if SCDs were properly functioning. Compliance was calculated as daily percentages of patients who were SCD compliant out of all patients with SCD orders, then averaged for the month. The most common barriers to compliance were identified, and together with nursing management, we designed and implemented a best practice alert to facilitate nursing education and supply chain management, at month 3. At, UF, we similarly began tracking patients under the trauma and acute care surgery teams on the surgical floor across 15 days, calculating daily SCD compliance percentages. The nursing flow sheets were also reviewed to assess if shift documentation of SCD compliance or refusal correlated with our daily observations.
Results: For BMC, compliance averaged 19.7% (n=95) during August, and 38.4% (n=131) in September. After implementing a best practice nursing alert and supply chain upgrades, compliance was 48.8% (n=150) in October and 45.9% (n=76) in April. Compliance was significantly improved from baseline in August to October (z=5.042). The significant difference was sustained through March (z=3.402) and April (z=3.730). Residual barriers to compliance included patient behavior and equipment malfunctions. At UF, daily compliance ranged from 15.8% to 66.7% and averaged 37.5% (n=255). There was no significant change in trend over the course of our brief observation. Whereas BMC uses the customizable Kendall SCD 700 series compression therapy pump™, UF uses the single setting ALP – alternating leg pressure machine™ without observed instances of machine malfunction, but with warmth from the wraps as the most common reason given for refusal.
Conclusion: While there was improvement of SCD compliance after implementing nursing-focused interventions at BMC, preliminary data at UF suggests that mandated nursing workflows are not associated with a higher rate of compliance. There is similar nursing autonomy observed across these institutions, but different functional statuses of the patient populations. Further study is warranted to overcome the modifiable barriers to compliance at BMC and UF.
