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Anti-embolism stockings – size selection in elective hip and knee replacement patients
Linda Woodsford (Orthopaedic Staff Nurse)
2012
Aims and objective of the audit:
• To improve patient safety, by reducing the number of orthopaedic patients being fitted with incorrect size anti-embolism stockings
at their initial assessment
• To reduce unnecessary expenditure to the trust, by reducing the number of anti-embolism stockings being replaced
Background
Numerous patients had their anti-embolism stockings discarded because they were either too small or too large.
Surgical stockings were not being sized correctly and subsequently had to be replaced.
Cost implications to the Ward / Trust.
Could impact on patient safety.
Awareness that:
Standard
1. 100% of anti-embolism stockings of the correct size should be fitted at the initial assessment.
2. To reduce unnecessary financial cost to the trust created through wastage.
3. To preserve and maintain patient safety.
Initial Audit 2403
• 8 out of 50 patients were fitted with the wrong size anti-embolism stockings.
• 7 out of 50 patients were on the cusp of two sizes, they were fitted with smaller rather than the larger size.
• 15 out of 50 patients were potentially placed at risk of developing DVT through poor practice.
(Woodsford 2011)
The initial audit confirmed my original impression
Initial auditWhat should
I do?Staff unaware they should fit larger size if on the cusp of
two sizes.
Packaging of stockings omits to mention surgical patients in any
format.
(Woodsford 2011)
No guidelines available
Not fully aware of implications to patient
Estimation of size
Actions promoting patient care
Staff unaware they should fit larger size if measurement
on the cusp of two sizes.
Estimation of size.
Not fully aware of implications to patient
Educate ward level
Drug chart VTE
Mandatory training days
Actions promoting patient care
Guidelines not available within trust
Write guidelines
Packaging of stockings omits to mention surgical patients in any format.
Discuss with company
Re-audit 2527
• 1 of 50 patients had anti-embolism stockings replaced, a reduction from 30% to 2%.
• No patients were identified as being on the cusp of two sizes.
• Approx minimum yearly saving of £500 (£51.77 over 6 week period).
• Packaging reworded.
(Woodsford 2012)
Audit cycle
Problemidentified
Initial audit 2403
Setting standards
Measuring current practice
Comparing results with standards
Changing practice
Re-auditing 2527
References
Miller, J., 2011. Use and wear of anti-embolism stockings: A clinical audit of surgical patients. (online) Available from: http://www.onlinelibrary.wiley.com/doi/10.1111/j.1742-481X.2010.00751.x/full (Accessed 18th July 2012).
SaphenaMEDICAL., 2011. Anti-embolism stockings:- Ward information pack. (online) Available from: http://www.gandn.com (Accessed 18th July 2012).
Woodsford, L., 2011. Anti-embolism stockings – size selection in elective hip and knee replacement patients: A clinical audit of surgical patients. Dorchester: Dorchester County Hospital.
Woodsford, L., 2012. Anti-embolism stockings – size selection in elective hip and knee replacement patients: A clinical audit of surgical patients. Dorchester: Dorchester County Hospital.
ANY QUESTIONS
?