Assessing the Quality of Use of Venous Thromboembolism (VTE) Prophylactic Devices for Stroke Patients at Leeds General Infirmary: An Audit and Re-audit.

BACKGROUND

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in patients suffering from stroke. Intermittent pneumatic compression devices (IPCs) and geko™ devices are used to reduce the risk of VTE in patients who have suffered an acute stroke. Correct use of the devices is essential for achieving the reduced risk of VTE.  Objectives: To assess the quality of use of VTE prophylactic devices by observing if they are both applied and working correctly. To identify and address factors that contribute to suboptimal use of VTE prophylactic devices.  Methods: Patients in beds 1-20 in the Acute Stroke Unit at Leeds General Infirmary were assessed on three separate days in June 2024. Data collected included: 'VTE prophylaxis prescribed', 'VTE prophylaxis in place and working correctly?', 'If not, how so?', 'Notes'. Following an intervention, an identical audit was performed three months later. A total of 41 and 42 patients were included in the audit and re-audit, respectively.

RESULTS

The audit included 35 patients who were prescribed IPCs (Kendall SCD™ 700 Smart Compression System) and demonstrated a very poor quality of use, with only 22.9% (n=35) observed to be in place and working correctly. The audit included six patients who were prescribed geko™ devices (Firstkind Ltd.) and found that 50% (n=6) were observed to be in place and working correctly. After a presentation of the results at local clinical governance and implementation of interventions, the re-audit demonstrated a substantial increase in the quality of use of both devices. The re-audit included 36 patients who were prescribed IPCs and six who were prescribed geko™ devices. The percentage of IPC and geko™ devices in place and working correctly increased to 75.0% (n=36, p<0.01) and 88.3% (n=6, p>0.01), respectively.  Conclusions: The intervention focused on increasing staff awareness of the importance of proper use of VTE prophylaxis and awareness of how to use the devices. It is reasonable to conclude that the improvement seen is a result of a change in these factors. To maintain and further improve quality, awareness of the importance of the devices and how to use them must also be maintained and improved. This should be done by additional systematic measures, such as regular training, and should be regularly reassessed.