Graduated compression stockings for the prevention of postoperative venous thromboembolism in obstetric patients: a best practice implementation project.

Ross-Adjie, Gail; McAllister, Helen; Bradshaw, Sue

AIMS The aims of this project were twofold: to compare our current venous thromboembolism management in postoperative Caesarean section patients with the current best evidence on the use of graduated compression stockings and to standardise mechanical venous thromboembolism prophylaxis guidelines where multiple approaches had previously been used. METHOD Thirty post-Caesarean section patients from a private hospital in Perth, Western Australia, were audited in a three-phase project: (i) the initial audit; (ii) clinical practice change including greater venous thromboembolism awareness and targeted education for midwives, standardised guidelines for mechanical prophylaxis, the development of an online venous thromboembolism module, a venous thromboembolism prophylaxis policy and heightened consumer involvement; and (iii) a follow-up audit. RESULTS Our initial audit result demonstrated opportunities for improvement across all audit criteria. The interventions were undertaken over a 3-month period from August to October 2010. The follow-up audit results showed pleasing improvements across four audit criteria with one criterion unchanged. CONCLUSION While the follow-up audit showed significant clinical improvements, the tight time frame for the development and implementation of multiple interventions created major challenges. We believe that given time to embed these changes, further improvements will be seen. Ongoing audits will be conducted to ensure the sustainability of these changes. The change in practice and subsequent improvements demonstrated at this private hospital provide evidence to encourage other midwifery units to pursue best practice in the management of this high-risk patient cohort.