Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.
Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
BMJ Open Qual. 2021 Jan;10(1). doi: 10.1136/bmjoq-2020-001171.
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 form of mechanical VTE prophylaxis, has been a focus of efforts to improve patient safety. At our institution, a baseline audit in July 2020 revealed that patients admitted to the trauma floors have poor compliance with the use of SCDs. In this quality improvement project, we developed a patient education intervention to improve SCD compliance. We distributed an informational flyer to patients and led short educational sessions on VTE risk factors and proper SCD use. Our aim was to increase our SCD compliance rate by 30% in 4 weeks. We used three plan-do-study-act (PDSA) cycles to implement and refine our intervention. We measured SCD compliance during morning and afternoon patient observations and generated run charts to understand how our cycles were leading to change. After a 4-week period, we did not achieve our aim, but increased our overall compliance from 45% to 60% and sustained this improvement throughout our PDSA cycles. Morning compliance was lower than afternoon compliance both at baseline (45% vs 48.5%) and at the end the project (45% vs 53%). Our results suggest that patient education should be coupled with interventions that address other barriers to SCD compliance.
静脉血栓栓塞症（VTE）是创伤患者中第四种最常见的报告并发症。对于这些患者，血栓预防是一种标准的护理。患者对连续压迫装置（SCD）的依从性，一种机械性 VTE 预防措施，一直是提高患者安全性的重点。在我们的机构中，2020 年 7 月的基线审核显示，入住创伤病房的患者对 SCD 的使用依从性很差。在这个质量改进项目中，我们开发了一种患者教育干预措施，以提高 SCD 的依从性。我们向患者发放了宣传传单，并就 VTE 风险因素和正确使用 SCD 进行了简短的教育课程。我们的目标是在 4 周内将我们的 SCD 依从率提高 30%。我们使用了三个计划-执行-研究-行动（PDSA）循环来实施和完善我们的干预措施。我们在早晨和下午的患者观察期间测量 SCD 的依从性，并生成运行图，以了解我们的循环如何带来变化。经过 4 周的时间，我们没有达到我们的目标，但将我们的整体依从率从 45%提高到 60%，并在整个 PDSA 循环中保持了这一提高。在基线时（45%比 48.5%）和项目结束时（45%比 53%），早晨的依从性都低于下午的依从性。我们的结果表明，患者教育应与解决 SCD 依从性其他障碍的干预措施相结合。
