Monica Davis

When sequential-compression devices cause falls.

Sequential-compression devices (SCDs) are noninvasive, safe, and effective in preventing deep-vein thrombosis in patients who are immobile or are in the postoperative period. SCD units include threechambered pneumatic sleeves placed around the patient’s legs. Tubing conveys air to the sleeves from an electric air-compression pump. The sleeve chambers inflate in a cycle, applying pressure in a sequence that starts at the ankle or foot and reaches to the calf or thigh. This motion simulates the squeezing action of muscle activity, thus increasing the volume and velocity of venous blood flow and reducing the risk of thrombosis. While the benefits of SCD use are well established in the literature, these devices also present an important, unforeseen risk to ambulatory patients. The dangling SCD tubing is a tripping hazard: when patients attempt to walk independently with the devices still on their legs, the risk of an injury from falling increases. Also, injuries from falls involving SCD are likely to be more severe than injuries associated with general patient falls. Although fewer than 0.1% of more than 100,000 fall reports submitted to the Pennsylvania Patient Safety Reporting System (PAPSRS) from June 2004 through mid-2005 indicated that SCDs were involved, those falls were more than three times as likely to be reported as “serious events” (those that harm the patient), compared with the falls in reports in which SCDs were not mentioned. While patients of every adult age group have fallen while wearing SCDs, the greatest number of falls occur among older adults. Among PA-PSRS reports of falls involving SCDs, 40% of patients were between the ages of 75 and 84. Half of reported falls involving SCDs occurred between midnight and 8 am, when staffing is reduced, lights are dim, bathroom visits are likely, and the unfamiliar surroundings can disorient patients. Patient toileting was associated with 58% of the falls involving the use of an SCD, whether the patient was ambulating to the bathroom, using a bedside commode, falling in the bathroom, or using a urinal to void. Of those reports detailed enough to indicate an immediate cause of the fall, most stated either that the patient had tripped over the tubing or that the compression sleeve had slipped down to the patient’s ankles and caused her or him to trip or lose balance. Much has appeared in the literature about falls and their prevention, but there is nothing about the role of SCDs as a risk factor in patient falls. Several of the following strategies to reduce the risk of falls related to SCDs are simple variations of widely used fall-prevention strategies: • Assess the continued need for SCDs, especially in mobile patients. • To prevent compression sleeves from slipping out of place, ensure that they’re properly sized and fit the leg By Janet Johnston, MSN, JD, RN, and Monica M. Davis, MSN, MBA, CRNP