Hospital Wide SCD patient education

[chylerlove]

Hello All,

I work in a relatively large hospital that utilizes teds/scds for the majority of our inpatient population. We have corrected issues with providers not ordering teds/scds via revisions to ordersets. However, one issue we are noticing is nurses are documenting "patient refused" but then another nurse goes in and explains the serious complications that SCDs could prevent and the patient enthusiastically complies. I am wondering if anyone has a creative idea for educating patients? All inpatients already receive an educational folder and many of the specialties (ortho, uro, neurosurg) provide pre-operative educational material. I am thinking something like a placemat that stays in each patient's room on the bedside table (taped down) that explains "why am I being asked to wear teds/scds?". What do you do at your hospital/anyone have any ideas? Thanks so much!

[MunoRN, RN]

I find this can happen when something like SCD's are ordered for patients where it's not actually indicated. Does your facility limit use to patients where SCD's are truly indicated, or does it try to keep it's compliance numbers up by trying to put them on everyone?

[chylerlove]

They have to be indicated and are typically utilized for total care patients, while strict bed rest is ordered, post-op day of surgery and post-op day 1 etc. I do see your point though as we have struggled with that issue in the past. Now the physician is allowed to choose an appropriate contraindication or chart that they are not indicated for the patient while similtaneously ordering appropriate DVT prophylaxis for that patient (i.e.: "ambulate patient in hall at least ____ xs each shift for DVT prophylaxis). I just think it would be nice to have something to understand and reference so that the patient is prepared that they may need SCDs during their stay and why they are so important (when actually indicated :) )

[CardiacKittyRN]

We were having a problem with compliance of TEDs/SCDs orders recently.. But it was mainly because they are in an order set and doctors were literally ordering them on EVERYONE. I work cardiac and a large majority of our pts are receiving IV Heparin or Integrillin, if not they are getting heparin subQ. For an ambulatory person this IS enough. I can see doing teds/SCDs on bed bound pts or those who are post op.

Usually walkie talkies don't want to wear them, but if you're getting up frequently they are a pain. I always educate before putting them on and then on my assessment round if they have an order and they're not in the room or on the pt I'll educate again.

If they refuse, just chart it. Then I usually also chart that they are receiving heparin gtt or on some other type of anticoagulation.

[dudette10, MSN, RN]

In my hospital, SCD/TED compliance with orders is also an issue. I've noticed that many nurses will not order the equipment, regardless of ambulatory status, because the patient is on heparin SQ. The reason I know this is because, every single shift, at least two of my patients have SCD orders, and I have to implement the order, even if the patient is not my admission. This is NOT acceptable.

Here's why:

"However, thrombosis prophylaxis with heparin or LMWH augmented with EPC devices was found to be more effective in preventing DVT compared to LMWH alone."

http://www.medscape.com/viewarticle/730319_11

Putting aside the fact that it is a patient safety issue, regardless of "inconvenience" of education and getting the supplies together, all we need is one instance of DVT where it is found that the nurses responsible for that patient have not implemented the SCD order.

[Graduatenurse14]

However, one issue we are noticing is nurses are documenting "patient refused" but then another nurse goes in and explains the serious complications that SCDs could prevent and the patient enthusiastically complies.

Ask those nurses who goes and explains the serious complications that SCDs could prevent exactly what they say and how they say it and then strongly encourage or even require that this is how patient education is done for SCDs now. It's worth a shot!