Improving Staff Compliance with Intermittent Pneumatic Compression (IPC) Therapy

Purpose:
In a large urban hospital, a recent study found 73% of patients with active orders for IPC therapy were observed not receiving therapy. Clinical nurse specialists, using a collaborative approach, designed interventions to decrease this aspect of missed care and ensure the consistent use of IPCs.

Background/Significance:
Routine prophylaxis for DVT and PEs reduces morbidity, mortality, and cost in hospitalized patients at risk. An audit found that among patients with active IPC orders, 73 % were not wearing the devices and 70 % of those patients were lying in bed. Additionally, 38% of patients with an active IPC order did not have equipment in their rooms and for 49% of patients reasons for non-compliance were unknown and not documented.

Methods:
A three phase study was conducted on two surgical units. Phase one involved a root cause analysis to determine if non-compliance was due to lack of device availability and if so, how it could be remedied. This phase included studying IPC device use on patients transferring in to the units and determining overall availability of devices. Phase two consisted of surveying nurses to determine if knowledge or practice gaps existed. Phase three of the study involved a pilot project designed to improve IPC device compliance on these two units. This phase included point prevalence counts and statistical analyses to determine if compliance changes were meaningful.

Results:
First phase results indicated patients transferring from units with a ready supply of IPC devices were more likely to be using the devices. Results from this phase also indicated that IPC device availability was approximately 2 times greater than active daily orders. These results indicated devices could be stored in patient rooms to improve compliance. Second phase results showed knowledge and practice gaps existed and compliance could improve with both nurse and patient education. Third phase Chi-Square results showed a statistically significant improvement in compliance with IPC usage during a one month pilot study on two units as compared to two units without the pilot intervention.

Conclusions and Implications for Practice:
Based on the results of the pilot study, the study team recommended a policy revision to include maintaining IPCs in patient rooms, annual nurse education, and new patient education materials. These resources are currently being deployed.