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

Abstract

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.