McWilliams Daniel, Zamani Rohid, Limaye Sameer
Stroke, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, GBR.
Trauma and Orthopaedics, George Eliot Hospital, Nuneaton, GBR.
Cureus. 2024 Dec 13;16(12):e75636. doi: 10.7759/cureus.75636. eCollection 2024 Dec.
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.
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.
静脉血栓栓塞症（VTE）是中风患者发病和死亡的重要原因。间歇性气动压迫装置（IPCs）和geko™装置用于降低急性中风患者发生VTE的风险。正确使用这些装置对于降低VTE风险至关重要。目的：通过观察VTE预防装置是否正确应用且正常工作来评估其使用质量。识别并解决导致VTE预防装置使用不佳的因素。方法：对利兹总医院急性中风单元1至20号床位的患者在2024年6月的三个不同日期进行评估。收集的数据包括：“开具的VTE预防措施”、“VTE预防措施是否到位且正常工作？”、“如果没有，情况如何？”、“备注”。在进行干预后，三个月后进行了相同的审核。审核和重新审核分别纳入了41名和42名患者。
审核包括35名开具了IPCs（Kendall SCD™ 700智能压迫系统）的患者，其使用质量非常差，仅22.9%（n = 35）的装置被观察到到位且正常工作。审核包括6名开具了geko™装置（Firstkind有限公司）的患者，发现50%（n = 6）的装置被观察到到位且正常工作。在当地临床治理中展示结果并实施干预措施后，重新审核显示两种装置的使用质量都有显著提高。重新审核包括36名开具了IPCs的患者和6名开具了geko™装置的患者。到位且正常工作的IPCs和geko™装置的百分比分别增至75.0%（n = 36，p < 0.01）和88.3%（n = 6，p > 0.01）。结论：干预措施侧重于提高工作人员对正确使用VTE预防措施重要性的认识以及对如何使用这些装置的认识。可以合理地得出结论，观察到的改善是这些因素变化的结果。为了维持并进一步提高质量，还必须维持并提高对这些装置重要性以及如何使用它们的认识。这应该通过额外的系统措施来实现，例如定期培训，并且应该定期重新评估。
