Improving Compliance Patient and Nurse With Scd Orders to Improve Patient Safety Term Paper

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patient nurse compliance with SCD - Deep Vein Thrombosis



The objective of this work is to focus on a clinical hospital-based problem that was encountered first in making identification of the problem and secondly to assess and analyze that which has caused the problem. Finally this work will plan and implement solutions through utilization of critical thinking and then evaluate the solution.


The scenario for this work in improving patient and nurse compliance with Sequential Compression Device (SCD) orders. The planning/implementing section should include a section about the uniqueness of the adult learner and strategies to impact the adult learner. Also, a mention of staff development workshops and education would be appropriate in this section.


Sequential Compression Devices, or SCD's, are designed to limit the development of Deep Vein Thrombosis (DVT) and Peripheral Edema in immobile patients. When a patient is immobile for long periods of time, as in recuperation from an injury, blood tends to pool in the calf area of the lower leg. To combat this tendency, clinicians use the Sequential Compression Device. This consists of an air pump connected to a disposable sleeve by a series of air tubes. The sleeve is placed around the patient's leg. Air is then forced into different parts of the sleeve in sequence, creating pressure around the calves and improving venous return.

I. Chang et al. (2002)Buy full Download Microsoft Word File paper
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Term Paper on Improving Compliance Patient and Nurse With Scd Orders to Improve Patient Safety Assignment

Chang, et al. (2002) report in the work entitled: "Compliance With Sequential Compression Device Prophylaxis in at-Risk Trauma Patients: A Prospective Analysis" that the Sequential Compression Device (SCD) is "frequently the sole measure used to prevent deep venous thrombosis (DVT) in trauma patients." They state the purpose in their study being the evaluation of the "the compliance with physician orders for the application of SCD prophylaxis among nonambulatory trauma patients at risk for DVT." (Chang et al., 2002) Chang et al. (2002) conducted a "prospective observational study at two Level 1 university-affiliated trauma centers." The study states that nonambulatory trauma patients were under observation "during their early post-admission period in a non-critical care setting. Six observations were made as to proper SCD applications during a 24-hour period (two times in the morning shift, two in the evening shift, and two overnight)."

Additionally stated is that: "Full compliance" was defined as: 'SCD on and functioning properly in all six observations.'"(Chang, et al. 2002) Findings of the study state that in 1343 total observations the following percentages as related to compliance.

42 patients (19%) were fully compliant

712 devices (53%) observations - Device was on and functioning

185 patients 83% (not fully complaint) - DVT risk factors were common (83%) and adjunctive heparin prophylaxis was infrequent (27%). (Chang et al., 2002)

Chang et al. (2002) states that: "The most common times for "noncompliant" observations were early afternoon and midmorning. On multivariate analysis only spinal column injury correlated with increased compliance. In nearly half of the observations trauma patients at risk for DVT were not receiving their SCD prophylaxis as per physician orders. Fewer than 20 per cent of patients had the devices on and functioning during each of the six observations during a 24-hour period. These data point to the need for education of hospital staff and for additional prophylactic measures in at-risk patients." (Chang et al., 2002)

II. Kehl-Preutt (2006)

Kehl-Preutt states in the work entitled: "Deep Vein Thrombosis in Hospitalized Patients: A Review of Evidence-based Guidelines for Prevention" published in the March/April 2006 issue of the Dimensions of Critical Care Nursing Journal that: "Venous thromboembolism results from a combination of venous stasis, vein injury, and increased coagulation, otherwise known as Virchow's triad. 1 Venous stasis occurs when patients are immobile and blood pools in the extremities, usually the leg veins. Vein injury can be the result of surgery, intravenous therapy, and phlebotomy. Increased coagulability is seen in inflammatory conditions and some infectious disease processes. To prevent venous thromboembolism, the 3 components of Virchow's triad must be minimized during hospitalization. Avoided could be the "...2 million people" who are documented to experience DVT every year. Kehl-Preutt relates that: "In a prospective study of data from this registry, 5 the DVT FREE Steering Committee reviewed data from 5,451 patients enrolled within a 6-month period and found that 2,726 developed DVT while hospitalized. Of those patients, 1,362 were medical patients and 1,364 were surgical patients. Seventy-one percent of these combined medical and surgical patients had not received any type of DVT prophylaxis 30 days prior to diagnosis. Researchers confirmed that routine preventive measures were not provided to 58% of medical patients." (2006) it is important that: "Critical care nurses... understand the risk factors for DVT and the various methodologies used to prevent this potentially life-threatening condition." (Kehl-Preutt, 2006)

III. AACN Journal Report (2006)

The American Association of Critical-Care Nurses Journal reports in its January 2006 issue in the work entitled: "Practice Alert: Deep Vein Thrombosis Prevention" that: the expected practice includes the assessment of all patients when admitted to the "ICU for risk factors of deep vein thrombosis (DVT) and anticipate orders for DVT prophylaxis based on risk assessment." (AACN, 2006) the nurse is responsible for:

1) daily review with the "physician and during multidisciplinary rounds each patient's current CVT risk factors including the clinical status, necessity for central venous catheter (CVC), current status of DVT prophylaxis, risk for bleeding and response to treatment;

2) Maximization of "patient mobility whenever possible and take measures to reduce the amount of time the patient is immobile because of the effects of treatment (e.g. pain, sedation, neuromuscular blockade, mechanical ventilation)"; and 3) Ensuring: "that mechanical prophylaxis devices are fitted properly and in use at all times except when being removed for cleaning and/or inspection of skin."(AACN Journal, 2006)

Stated in the AACN Journal report as being that which should be complied to within all units are the following:

1) "Ensure that your unit has a written policy for DVT prophylaxis that is updated regularly to reflect emerging evidentiary findings in addition to preprinted or computerized ICU admission orders";

2) "Ensure that your unit has an organized process for developing and communicating patient goals (which include DVT prophylaxis) to members of the multidisciplinary team";

3) "Establish a process to educate and routinely evaluate all staff in the use of mechanical prophylaxis devices";

4) "Review orders of patients discharged from the ICU to ensure that transfer orders include a plan for DVT prophylaxis";

5) "Monitor your unit's compliance with DVT prophylaxis policies and rates of DVT and pulmonary embolism. Initiate quality improvement initiatives involving a multidisciplinary team as necessary." (2006)

The report relates that:" Improperly fitted graduated compression stockings producing a reversed pressure gradient were associated with a statistically significantly higher incidence of DVT compared with stockings that produced a proper gradient.35 Studies evaluating compliance with intermittent pneumatic compression devices demonstrated rates of non-compliance ranging from 22% to 81% in at-risk patients." (AACN Journal, 2006)

IV. Morris & Woodcock (2004)

Morris & Woodcock (2004) state in the work entitled: "Evidence-based Prevention of Stasis and Deep Vein Thrombosis" published in the Annals of Surgery Journal (2004) state that their objective as being the summary of "the currently published scientific evidence for the venous flow effects of mechanical devices, particularly intermittent pneumatic compression, and the relation to prevention of deep vein thrombosis (DVT)." (2004) Morris and Woodcock (2004) state that: "While intermittent pneumatic compression is an established method of DVT prophylaxis, the variety of systems that are available can use very different compression techniques and sequences. In order for appropriate choices to be made to provide the optimum protection for patients, the general performance of systems, and physiological effects of particular properties, must be analyzed objectively." The study concludes that: "The most important factors in selecting a mechanical… [END OF PREVIEW] . . . READ MORE

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