A Closed-Loop Audit of Thrombo-Embolic Deterrent Stocking Use in an Orthopaedic Ward.

In Ireland, 63% of venous thromboembolism (VTE) cases develop in hospitals. In orthopaedics, 45 – 51% of inpatients develop deep vein thrombosis without adequate thromboprophylaxis. Thrombo-embolic deterrent stockings (TEDS) exert circumferential pressure, reducing venous diameter, increasing venous blood flow, and limiting venous distension. Correct use maximises benefits while incorrect use can cause constriction and distal stagnation. This audit aimed to assess patient adherence to the correct use of TEDS and whether they had received the appropriate education regarding TEDS. A closed-loop audit was conducted in the orthopaedic specialty ward of a teaching hospital in Dublin, Ireland. Phase one was conducted over two weeks in June 2023 and phase two was conducted over two weeks in September 2023. Each phase involved collecting data from 20 patients. An educational intervention was conducted between each phase to remind ward staff to monitor patient adherence to TEDS and educate patients regarding the importance of TEDS. An educational poster was also created. Phase one revealed that only 11 (55%) patients were wearing TEDS correctly and only 13 (65%) were educated on the importance of TEDS. In phase two, after the educational intervention, there was an improvement in patient adherence and knowledge. 18 (90%) patients were wearing TEDS correctly and 16 (80%) had been properly educated. This audit showed that monitoring and education by ward staff are vital in improving patient adherence to wearing TEDS. Evidence shows that mechanical thromboprophylaxis is beneficial in reducing thromboembolic events. Regular audits should be continued to ensure these behaviours are maintained.

Content

Author and article information

Journal

Title: ScienceOpen Preprints

Publisher: ScienceOpen

Publication date (Electronic preprint): 15 March 2024

Affiliations

[1 ] School of Medicine, Trinity College Dublin, Dublin, Ireland;

[2 ] Department of Trauma and Orthopaedic Surgery, St. James’s Hospital, Dublin, Ireland;

Author notes

[* ]Email: limkengkiatbrandon@ 123456gmail.com .

Author information

Brandon Lim https://orcid.org/0009-0006-5999-8364

Article

DOI: 10.14293/PR2199.000761.v1

SO-VID: 6cf72cb1-cb5a-464f-a642-b719d6e9bdd3

License:

This work has been published open access under Creative Commons Attribution License CC BY 4.0 , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com .

History

Date received : 15 March 2024

References

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Walker Linda, Lamont Sue. The use of antiembolic stockings. Part 1: a literature review. British Journal of Nursing. Vol. 16(22):1408–1412. 2007. Mark Allen Group. [Cross Ref]
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Sustersic Mélanie, Tissot Marisa, Tyrant Julie, Gauchet Aurelie, Foote Alison, Vermorel Céline, Bosson Jean Luc. Impact of patient information leaflets on doctor–patient communication in the context of acute conditions: a prospective, controlled, before–after study in two French emergency departments. BMJ Open. Vol. 9(2)2019. BMJ. [Cross Ref]
Adepu R, Swamy MK. Development and evaluation of patient information leaflets (PIL) usefulness. Indian Journal of Pharmaceutical Sciences. Vol. 74(2)2012. OMICS Publishing Group. [Cross Ref]
See Min Ting Alicia, Chan Wai-Chi Sally, Huggan Paul John, Tay Yee Kian, Liaw Sok Ying. Effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions. Patient Education and Counseling. Vol. 97(1):122–127. 2014. Elsevier BV. [Cross Ref]
Lim Chung Sim, Davies Alun H.. Graduated compression stockings. Canadian Medical Association Journal. Vol. 186(10)2014. CMA Joule Inc. [Cross Ref]
Bratzler Dale W.. Development of national performance measures on the prevention and treatment of venous thromboembolism. Journal of Thrombosis and Thrombolysis. Vol. 29(2):148–154. 2010. Springer Science and Business Media LLC. [Cross Ref]

Comments

Comment on this article

[1] Moheimani Fatemeh, Jackson Denise E.. Venous Thromboembolism: Classification, Risk Factors, Diagnosis, and Management. ISRN Hematology. Vol. 2011:1–7. 2011. Hindawi Limited. [Cross Ref]

[2] Wade Ros, Paton Fiona, Rice Stephen, Stansby Gerard, Millner Peter, Flavell Hayley, Fox Dave, Woolacott Nerys. Thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis in postoperative surgical patients; a systematic review and network meta-analysis. BMJ Open. Vol. 6(2)2016. BMJ. [Cross Ref]

[3] Chung Irene, Lip Gregory Y.H.. Virchow’s Triad Revisited: Blood Constituents. Pathophysiology of Haemostasis and Thrombosis. Vol. 33(5-6):449–454. 2003. S. Karger AG. [Cross Ref]

[4] Bagot Catherine N., Arya Roopen. Virchow and his triad: a question of attribution. British Journal of Haematology. Vol. 143(2):180–190. 2008. Wiley. [Cross Ref]

[5] Kumar D. R., Hanlin E., Glurich I., Mazza J. J., Yale S. H.. Virchow's Contribution to the Understanding of Thrombosis and Cellular Biology. Clinical Medicine & Research. Vol. 8(3-4):168–172. 2010. Marshfield Clinic Research Institute. [Cross Ref]

[6] Meesters Jorit, Conijn D, Vermeulen HM, Vliet Vlieland TPM. Physical activity during hospitalization: Activities and preferences of adults versus older adults. Physiotherapy Theory and Practice. Vol. 35(10):975–985. 2019. Informa UK Limited. [Cross Ref]

[7] Kirk Asher G., Behm Kate J., Kimmel Lara A., Ekegren Christina L.. Levels of Physical Activity and Sedentary Behavior During and After Hospitalization: A Systematic Review. Archives of Physical Medicine and Rehabilitation. Vol. 102(7):1368–1378. 2021. Elsevier BV. [Cross Ref]

[8] Miller Julie A. Use and wear of anti-embolism stockings: a clinical audit of surgical patients. International Wound Journal. Vol. 8(1):74–83. 2011. Wiley. [Cross Ref]

[9] Walker Linda, Lamont Sue. The use of antiembolic stockings. Part 1: a literature review. British Journal of Nursing. Vol. 16(22):1408–1412. 2007. Mark Allen Group. [Cross Ref]

[10] Miller Julie A. Use and wear of anti-embolism stockings: a clinical audit of surgical patients. International Wound Journal. Vol. 8(1):74–83. 2011. Wiley. [Cross Ref]

[11] Donnelly T, McNeely B. The Shocking Stocking Audit: An Audit on the Use of Thromboembolic Deterrent Stockings (Teds) for Patients Having Surgery at Sligo Regional Hospital. Journal of Perioperative Practice. Vol. 25(4):83–86. 2015. SAGE Publications. [Cross Ref]

[12] Kakkos Stavros, Kirkilesis George, Caprini Joseph A, Geroulakos George, Nicolaides Andrew, Stansby Gerard, Reddy Daniel J. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database of Systematic Reviews. Vol. 2022(1)2022. Wiley. [Cross Ref]

[13] Hajouli Said. Massive Fatal Pulmonary Embolism While on Therapeutic Heparin Drip. Journal of Investigative Medicine High Impact Case Reports. Vol. 8:2020. SAGE Publications. [Cross Ref]

[14] Sachdeva Ashwin, Dalton Mark, Lees Timothy. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database of Systematic Reviews. Vol. 2019(4)2018. Wiley. [Cross Ref]

[15] Sobieraj Diana M., Coleman Craig I., Tongbram Vanita, Chen Wendy, Colby Jennifer, Lee Soyon, Kluger Jeffrey, Makanji Sagar, Ashaye Ajibade, White C. Michael. Comparative Effectiveness of Combined Pharmacologic and Mechanical Thromboprophylaxis versus Either Method Alone in Major Orthopedic Surgery: A Systematic Review and Meta‐analysis. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. Vol. 33(3):275–283. 2013. Wiley. [Cross Ref]

[16] Autar Ricky. A review of the evidence for the efficacy of Anti-Embolism Stockings (AES) in Venous Thromboembolism (VTE) prevention. Journal of Orthopaedic Nursing. Vol. 13(1):41–49. 2009. Elsevier BV. [Cross Ref]

[17] Gill Sukhdeep K., Pearce Andrea R., Everington Tamara, Rossiter Nigel D.. Mechanical prophylaxis, early mobilisation and risk stratification: as effective as drugs for low risk patients undergoing primary joint replacement. Results in 13,384 patients. The Surgeon. Vol. 18(4):219–225. 2020. Elsevier BV. [Cross Ref]

[18] Sugano Nobuhiko, Miki Hidenobu, Nakamura Nobuo, Aihara Masaharu, Yamamoto Kengo, Ohzono Kenji. Clinical Efficacy of Mechanical Thromboprophylaxis Without Anticoagulant Drugs for Elective Hip Surgery in an Asian Population. The Journal of Arthroplasty. Vol. 24(8):1254–1257. 2009. Elsevier BV. [Cross Ref]

[19] Shalhoub Joseph, Lawton Rebecca, Hudson Jemma, Baker Christopher, Bradbury Andrew, Dhillon Karen, Everington Tamara, Gohel Manjit S, Hamady Zaed, Hunt Beverly J, Stansby Gerard, Warwick David, Norrie John, Davies Alun H. Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT. Health Technology Assessment. Vol. 24(69):1–80. 2020. National Institute for Health and Care Research. [Cross Ref]

[20] T Oberai, K Laver, R Woodman, M Crotty, G Kerkhoffs, R Jaarsma. The effect of an educational intervention to improve orthopaedic nurses’ knowledge of delirium: A quasi-experimental study. International Journal of Orthopaedic and Trauma Nursing. Vol. 42:2021. Elsevier BV. [Cross Ref]

[21] Wand Anne P.F., Thoo William, Sciuriaga Hayley, Ting Vicky, Baker Janett, Hunt Glenn E.. A multifaceted educational intervention to prevent delirium in older inpatients: A before and after study. International Journal of Nursing Studies. Vol. 51(7):974–982. 2014. Elsevier BV. [Cross Ref]

[22] Tabet N.. An educational intervention can prevent delirium on acute medical wards. Age and Ageing. Vol. 34(2):152–156. 2005. Oxford University Press (OUP). [Cross Ref]

[23] Sustersic Mélanie, Gauchet Aurélie, Foote Alison, Bosson Jean‐Luc. How best to use and evaluate Patient Information Leaflets given during a consultation: a systematic review of literature reviews. Health Expectations. Vol. 20(4):531–542. 2017. Wiley. [Cross Ref]

[24] Al Jeraisy Majed, Alshammari Heba, Albassam Mashael, Al Aamer Kholoud, Abolfotouh Mostafa A.. Utility of patient information leaflet and perceived impact of its use on medication adherence. BMC Public Health. Vol. 23(1)2023. Springer Science and Business Media LLC. [Cross Ref]

[25] Sustersic Mélanie, Tissot Marisa, Tyrant Julie, Gauchet Aurelie, Foote Alison, Vermorel Céline, Bosson Jean Luc. Impact of patient information leaflets on doctor–patient communication in the context of acute conditions: a prospective, controlled, before–after study in two French emergency departments. BMJ Open. Vol. 9(2)2019. BMJ. [Cross Ref]

[26] Adepu R, Swamy MK. Development and evaluation of patient information leaflets (PIL) usefulness. Indian Journal of Pharmaceutical Sciences. Vol. 74(2)2012. OMICS Publishing Group. [Cross Ref]

[27] See Min Ting Alicia, Chan Wai-Chi Sally, Huggan Paul John, Tay Yee Kian, Liaw Sok Ying. Effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions. Patient Education and Counseling. Vol. 97(1):122–127. 2014. Elsevier BV. [Cross Ref]

[28] Lim Chung Sim, Davies Alun H.. Graduated compression stockings. Canadian Medical Association Journal. Vol. 186(10)2014. CMA Joule Inc. [Cross Ref]

[29] Bratzler Dale W.. Development of national performance measures on the prevention and treatment of venous thromboembolism. Journal of Thrombosis and Thrombolysis. Vol. 29(2):148–154. 2010. Springer Science and Business Media LLC. [Cross Ref]