Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design

Background/problem statement Venous thromboembolism (VTE) is the leading cause of preventable hospital mortality in the United States; however, compliance with VTE prophylaxis is poor. Most materials for education about VTE prophylaxis are oriented toward adults rather than adolescents, for whom VTE risks are lower and prophylaxis indications differ. We hypothesized that educational materials for adolescents could improve compliance with VTE prophylaxis, reduce nurse burden for initiating and maintaining VTE prevention practices, and reduce practice variation by standardizing the conversation between clinicians and patients. Methods A multidisciplinary team including physicians, nurses, quality experts, communication designers, service designers, and medical students applied a human-centered design (HCD) process to define, iteratively prototype, and test education tools for nurses assigned to adolescents. We piloted a suite of six educational tools for adolescent VTE prophylaxis to fit into the existing hospital workflow. Results An in-room poster was selected after 85% of nurses responded favorably to this intervention. Adolescent adherence with Intermittent Pneumatic Compression Device increased from 69% to 79%, attaining the benchmark goal of 78%. Staff reported greater confidence in educating adolescent patients after the intervention: 62% of nurses and 72% of residents. Conclusion An HCD process helped nurses improve VTE prophylaxis for adolescents with an in-room poster and messaging strategy. Engaging staff in the design increased receptivity and adoption. The piloted materials also helped to create an environment of shared priority among the clinicians.

Clinical Effectiveness of a Pneumatic Compression Device Combined with Low-Molecular-Weight Heparin for the Prevention of Deep Vein Thrombosis in Trauma Patients: a Retrospective Cohort Study

Purpose: To investigate the clinical effectiveness of a pneumatic compression device (PCD) combined with low-molecular-weight heparin (LMWH) for the prevention and treatment of deep vein thrombosis (DVT) in trauma patients.Materials and Methods: This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020. Patients treated with only LMWH were used as the control group, and patients treated with a PCD combined with LMWH were used as the observation group. The incidence of DVT, the postoperative change in the visual analog scale (VAS) score and coagulation function were observed and compared between the two groups. Excluding the influence of other single factors, binary logistic regression analysis can indicate whether the use of a PCD effectively improves the patient's postoperative coagulation function.Result: The incidence of DVT in the observation group was significantly lower than that in the control group (7.1% vs. 16.7%, respectively, χ2=4.605, P<0.05). The postoperative VAS scores of the two groups were lower than those before surgery (P<0.05). The coagulation function of the LMWH+PCD group was significantly higher than that of the LMWH group, and the combined anticoagulant effect was better (P<0.05). There were no significant differences between the two groups in terms of preoperative and postoperative Glasgow coma scores, intraoperative blood loss, postoperative infection rate, or length of hospital stay (P>0.05). According to binary logistic regression analysis, the postoperative risk of DVT in patients with LMWH alone was 1.764 times that with the combination of LMWH+PCD (P <0.05). The incidence of DVT with LMWH alone was 1.37 times that with the combined application. Activated partial thromboplastin time (APTT), platelet (PLT) count, and DVT are independent risk factors that indicate the need for a PCD (P <0.05). Excluding the influence of other variables, LMWH+PCD can effectively improve the coagulation function of patients. The area under the curve data indicate that APTT and PLT are sensitive indicators of anticoagulant efficacy (Z inspection, inspection level α = 0.05). Conclusion: Compared with LMWH alone, PCD combined with LMWH can improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture, significantly reduce the incidence of DVT, shorten the hospital stay and improve the clinical effectiveness of treatment.