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

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