Authors: (including presenting author): :
Lam WY (1), Lam LM (1), Wong WK (1)
Affiliation: :
(1) Orthopaedics & Traumatology, Tseung Kwan O Hospital
Keyword 1: :
Enhancing Practice Standards
Keyword 2: :
Early Detection of Deep Vein Thrombosis
Keyword 3: :
Patient Safety
Introduction: :
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), are common but also fatal in orthopedic wards, especially followed by surgeries involving lower limbs. Prolonged immobilization, fractures and dehydration elevate VTE risk significantly. As daily calf circumference measurement is a cost-effective and non-invasive screening tool, it is essential for early detection of complications.
Currently, our department lacks standardized guidelines for calf circumference measurement. A pre-survey of nursing staff highlighted considerable discrepancies in measurement techniques, including variations in measurement sites and patient’s posture, leading to unreliable data regarding DVT, muscle atrophy and treatment efficacy. Therefore, a standardized protocol is necessary and a quality improvement program is implemented to meet our needs for enhancing the accuracy and clinical utility of calf circumference measurement.
Objectives: :
•To standardize calf circumference measurement protocol for suspected DVT cases.
•To enhance staff knowledge related to calf circumference measurement for DVT diagnosis.
•To facilitate prompt clinical detection of DVT, therefore improving patient safety.
Methodology: :
After a comprehensive literature review, the UK's National Institute for Health and Care Excellence (NICE) guideline was adopted and standardizing calf circumference measurement at 10cm below the tibial tuberosity. A standardized flowchart and documentation chart were implemented to ensure consistency and ease of data entry. In order to assess the staff knowledge, staff confidence level of the skill and the existing practices, a pre-survey was conducted in an orthopedic ward. Then a multi-modal training package was developed after identifying the knowledge gap. The training package, including a quick guide, EBP newsletter, instructional video and informative poster, standardizes calf circumference measurement methods and addresses misconceptions. Also, the instructional video was accessible via QR code to reinforce proper techniques and consistency. Continuous feedback was collected to enhance the program’s relevance and effectiveness.
Result & Outcome: :
Pre-survey data (n=24) confirmed significant practice variation and knowledge gaps. Post intervention feedback indicated high staff satisfaction and an increase in confidence and consistency regarding the standardized calf circumference data. This led to more consistent identification of clinically significant unilateral swelling (e.g. >/ 3cm difference), forming a reliable foundation for DVT risk assessment and appropriate clinical escalation. In conclusion, standardizing calf circumference measurement is crucial for preventing missed DVT diagnoses and aligning the communication between nursing and allied health colleagues. The enhancement program has improved the reliability and integration of calf circumference measurement into patient care, effectively identifying DVT risks and ultimately promoting patient safety.
