1. Anti-embolism stockings – size selection in elective hip and knee replacement patients Linda Woodsford (Orthopaedic Staff Nurse) 2012

2. 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

3. 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:

4. 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.

5. 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

6. Initial audit What 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

7. 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

8. 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

9. 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)

10. Audit cycle Problem identified Initial audit 2403 Setting standards Measuring current practice Comparing results with standards Changing practice Re-auditing 2527

11. 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/full481X.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).http://www.gandn.com 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.

12. ANY QUESTIONS ?