University of Florida, Gainesville, Florida, USA
Boston University, Boston, Massachusetts, USA.
BMJ Open Qual. 2024 Aug 5;13(3):e002807. doi: 10.1136/bmjoq-2024-002807.
Sequential compression devices (SCDs) are the mainstay of mechanical prophylaxis for venous thromboembolism in perioperative neurosurgical patients and are especially crucial when chemical prophylaxis is contraindicated.
This study aimed to characterise and improve SCD compliance in neurosurgery stepdown patients.
SCD compliance in a neurosurgical stepdown unit was tracked across 13 months (August 2022-August 2023). When not properly functioning, the missing element was documented. Compliance was calculated daily in all patients with SCD orders, and then averaged monthly. Most common barriers to compliance were identified. With nursing, we implemented a best practice alert to facilitate nursing education at month 3 and tracked compliance over 9 months, with two breaks in surveillance. At month 12, we implemented a patient-engagement measure through creating and distributing a patient-directed infographic and tracked compliance over 2 months.
Compliance averaged 19.7% (n=95) during August and 38.4% (n=131) in September. After implementing the best practice alert and supply chain upgrades, compliance improved to 48.8% (n=150) in October, 41.2% (n=104) in March and 45.9% (n=76) in April. The infographic improved compliance to 51.4% (n=70) in July and 55.1% (n=34) in August. Compliance was significantly increased from baseline in August to October (z=4.5838, p<0.00001), sustained through March (z=3.2774, p=0.00104) and further improved by August (z=3.9025, p=0.0001).
Beyond an initial Hawthorne effect, implementation of the best practice nursing alert facilitated sustained improvement in SCD compliance despite breaks in surveillance. SCD compliance nonetheless remained below 50% until implementation of patient-engagement measures which were dependent on physician involvement.
连续压迫装置（SCD）是围手术期神经外科患者预防静脉血栓栓塞的主要手段，在化学预防禁忌时尤其重要。
本研究旨在描述和提高神经外科术后病房患者 SCD 的依从性。
在 13 个月（2022 年 8 月至 2023 年 8 月）内跟踪神经外科术后病房的 SCD 依从性。当设备未正常运行时，记录缺失的部件。对所有有 SCD 医嘱的患者进行每日计算，并按月平均。确定了最常见的依从性障碍。与护理团队合作，我们实施了最佳实践提醒，以促进 3 个月时的护理教育，并在 9 个月的时间内跟踪依从性，在此期间进行了两次监测中断。在第 12 个月，我们通过创建和分发患者导向的信息图实施了一项患者参与措施，并在 2 个月内跟踪了依从性。
8 月的依从率平均为 19.7%（n=95），9 月为 38.4%（n=131）。实施最佳实践提醒和供应链升级后，10 月的依从率提高到 48.8%（n=150），3 月为 41.2%（n=104），4 月为 45.9%（n=76）。信息图将依从率提高到 7 月的 51.4%（n=70）和 8 月的 55.1%（n=34）。与 8 月相比，8 月至 10 月的依从率显著增加（z=4.5838，p<0.00001），3 月时持续（z=3.2774，p=0.00104），8 月时进一步提高（z=3.9025，p=0.0001）。
除了最初的霍桑效应外，实施最佳实践护理提醒有助于在监测中断的情况下持续提高 SCD 的依从性。然而，SCD 的依从率仍低于 50%，直到实施依赖于医生参与的患者参与措施。
