Venous thromboembolism (VTE) is a significant concern in healthcare, being a leading cause of preventable hospital deaths and readmissions following surgery. Even though as many as 70% of healthcare-associated VTE cases are preventable, fewer than half of hospitalized patients receive preventative measures.
Our recent blog explored the dual approach to VTE prevention, detailing the role of pharmacological and mechanical prophylaxis and when to use each based on established clinical guidelines, studies, and risk stratifications. Mechanical prophylaxis is regularly recommended for use in combination with pharmacologic prophylaxis to reduce the incidence of VTE, particularly in surgical patients. It also plays a crucial role in preventing VTE in patients at high risk of bleeding or those who cannot receive pharmacological prophylaxis.
However, despite the benefits of mechanical prophylaxis, the current standard of care Intermittent Pneumatic Compression (IPC) devices are failing patients due to significant limitations that impact their effectiveness and patient safety. Nonadherence to recommended use of IPCs is an ongoing problem and frequently leads healthcare staff to opt for pharmacological approaches, even in mid-to-low-risk patients who may not require medication.
Patient Compliance: A Major Challenge
One of the primary limitations of traditional IPC devices is patient compliance, which is critical for achieving optimal therapeutic outcomes. Studies have shown that adherence to IPC devices can be as low as 40%.
Non-compliance with prescribed mechanical prophylaxis protocols can result in insufficient treatment, increased risk of blood clots, and costly medical interventions. Multiple studies have identified reasons for non-compliance, including discomfort associated with wrapping a non-breathable air bladder around the leg. These sleeves cause sweating, increasing discomfort and leading patients to use their call light and have the nurse remove the device. Patients have reported trouble sleeping due to the noise generated by IPC devices, and multiple, cumbersome tubes and cords hinder patient mobility—a key preventive measure to reduce the risks of VTE.
These factors make it difficult for patients and caregivers to achieve compliance with the recommended therapeutic wear time of 18 to 22 hours daily.
Exploring the Impact Traditional IPC Devices Have on Mobility
IPC devices are not intended as standalone treatments; they are often integrated into a comprehensive approach that includes additional preventive measures such as early and progressive mobility. However, IPC devices, like other medical equipment such as IV poles, can hinder patient mobility in the hospital setting. The presence of multiple cords and tubes can significantly impact mobility by essentially tethering patients to their beds, increasing the risk of falls and creating a reluctance to mobilize for both patients and healthcare workers. Furthermore, if the IPC Sleeves are removed for patient mobilization, they are not always reapplied in a timely manner.
Strategies to Enhance Compliance and Mobility
One approach to enhance compliance and mobility is focusing on practical ways to remove some of the barriers presented by traditional IPC devices in the healthcare setting. Several strategies can be employed to overcome these limitations:
- Cordless and Tubeless Devices: Multiple cords and tubes connected to IPC devices tether patients to the bed and hinder their mobility. When patients are ready to mobilize, healthcare workers are typically called into the room to disconnect/reconnect the tubes and reposition the sleeves, taking them away from other critical duties. Not only that, they present a trip and fall hazard for both patients and staff. Using cordless and tubeless wearable therapeutic compression devices can promote safe mobility and increase compliance.
- Improved Patient Comfort: Focusing on patient comfort by providing a compression device that is lightweight, quiet, and breathable can increase compliance and improve patient outcomes. Additionally, features such as moisture-wicking straps and a pressure prevention pad allow for breathability and maximum patient comfort.
- Incorporating a Data-Driven Approach with Compliance and Mobility Data: A data-driven approach can enhance clinical usability and provide accurate documentation of patient mobility levels and wear time compliance. This data helps empower healthcare providers with actionable insights to improve patient outcomes and make informed decisions on their care.
New technologies, such as wearable mobile compression devices, offer promising solutions to the existing limitations of traditional IPC devices. These devices are more comfortable and allow patients to mobilize with ease while also measuring mobility to provide critical data to monitor adherence. This ultimately increases compliance and the effectiveness of recommended mechanical prophylaxis protocols.
Evidence-Based Results: The Impact of Wearable Mobile Compression Devices
Studies have shown that wearable therapeutic compression devices, such as the Movement And Compressions™ (MAC) System, can lead to significantly longer wear times, improved patient satisfaction, and enhanced mobility. For example, a study published in an international, peer-reviewed trauma nursing journal aimed to determine whether using the MAC System compared with an IPC device impacts compliance with mechanical VTE prophylaxis in trauma patients. The results concluded that the absence of cords and tubes promotes safe mobility. This significantly influenced compliance and enabled patients to be mobilized safely without the need to unplug/re-plug the device.
Patients who used the cordless and tubeless mechanical prophylaxis device exhibited considerably more time upright than patients using the current standard of care IPC. The difference was attributed to its ability to provide real-time mobility data on the patient’s upright time, walking time, and the number of steps taken.
A recent Quality Improvement (QI) project noted that improving patient comfort, independence, and satisfaction by utilizing the cordless, tubeless, non-pneumatic MAC device led to a 92% increase in compliance, reduced the incidence of VTEs over a 7-month period, and improved overall patient safety. It allowed patients to receive VTE prophylaxis and mobilize simultaneously (i.e., dangle their legs at the side of the bed, get to the chair, and ambulate).
A comparative study published in the American Journal of Nursing highlighted the potential of the MAC System to improve patient outcomes and reduce the risk of VTE. Key findings include:
- Significantly longer wear time, with more patients wearing the novel mechanical compression device for at least 18 hours per day.
- Tripping hazards created by tubes and cords on current IPC devices and the negative impact on mobility were substantially improved using the novel mechanical compression device.
- The device resulted in improved patient comfort and significantly greater patient satisfaction with achieving mobility goals.
- The system’s data-driven approach enhanced clinical usability for nurses, with accurate documentation of patient mobility levels.
Conclusion
Since the National Institutes of Health (NIH) 1986 Consensus Development Statement on the effectiveness of external pneumatic compression, IPC devices have been the standard of care in the hospital. In the 30-plus years following this adoption, the mechanism for moving blood and providing needed prophylaxis remains consistent and unchanged.
The limitations of traditional IPC devices are a significant concern in preventing VTE, often leading to an overreliance on pharmacological prophylaxis methods for patients that do not require them, as well as increased risk in patients where pharmacological methods are contraindicated. Nonadherence to recommended prophylaxis with IPC devices can lead to costly medical interventions that could often be prevented. However, by acknowledging these limitations and adopting innovative alternatives that address the shortcomings of the standard of care IPC devices, healthcare providers can improve patient outcomes and reduce the risk of VTE.
The shift towards cordless, tubeless devices is shaping the future of compression therapy. Evidence suggests that wearable mobile compression devices like the MAC System can significantly enhance compliance, mobility, and patient satisfaction.