237 - Applying EBP to ReBoot Orthopedic Spine Patient SCD Protocol

Description: At our level 1 trauma center, surgeons for patients undergoing orthopedic spine surgery have traditionally ordered, and perioperative nurses have applied, thigh-length sequential compression device (SCD) sleeves in the operating room as part of our deep vein thrombosis (DVT) prophylaxis protocol. However, for all other orthopedic surgical patients, knee-length SCD sleeves are used successfully. This led nursing staff to the clinical question: In adult spine surgery patients, does the use of knee-length SCD sleeves, vs. the current practice of thigh-length SCD sleeves, affect post-op DVT rates or patient experience?
A literature review by a staff nurse and nurse scientist showed multiple researchers have found that reducing VTE risk can be done with early mobilization and intraoperative and post-op SCD use (Kepler, et al., 2018; Alvarado, et.al., 2019; Epstein, 2005), but none of their studies specified knee- vs. thigh-length sleeves. Patient care guidelines from the North American Spine Society (NASS), American Society of Hematology, and American College of Chest Physicians suggest mechanical prophylaxis to prevent VTE in surgical patients, but do not specify knee- vs. thigh-length sleeve use. There is weak to little research showing a clinical difference in DVT rate between knee- and thigh-length SCD sleeves. Our facility policy for VTE prophylaxis in spine surgery patients does not specify the type of SCD sleeve used, however other policies specifically state to use knee-length SCD sleeves.
SCD sleeves must be sized correctly to be effective - thigh-length sleeves can cause a tourniquet effect if they are too tight around the upper legs (Burlingame, 2010). Post-op compliance is better for staff and patients with knee-length sleeves as they are more comfortable for patient experience and easier to apply than thigh-length (Larkin, et al. 2012) (Burlingame, 2010) (Brady, et al., 2007) (Stone & Chamberlin, 2011).
The recommendation to use knee-length SCD sleeves on spine surgical patients was presented to the spine surgeons and leaders for approval. Staff education was provided, to include staff in the intra-op, post-op and floor units. An intervention start date was set and surgeon preference cards were updated. Staff were surveyed regarding the use of thigh- and knee-length SCD sleeves. VTE rates will be monitored. We expect to see no change in VTE rates after implementation of knee-length SCD sleeves. We expect staff approval of the change and reports of improved patient experience.
Perioperative nurses implement care that is continued through the patient's inpatient journey. Practicing with a questioning attitude and providing scientific evidence rather than accepting the way we have always done things can positively affect patient care, improve staff satisfaction with processes and in supplies used, decrease cost of care (estimated at over $5,000/year), and minimize the environmental impact.

References
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