NU 476 Unit 2 practice gap evidenced at the site example

Practice Gap Analysis: Intermittent Pneumatic Compression Devices Ordered but Not Working on a Surgical Unit

Student Name

Department of Nursing, Herzing University

NU 476: Nursing Capstone

Instructor Name

January 28, 2026

Practice Gap Analysis: Intermittent Pneumatic Compression Devices Ordered but Not Working on a Surgical Unit

What Should Happen

For surgical patients at moderate or high risk of venous thromboembolism, and especially for those at high risk of bleeding in whom anticoagulants are withheld, clinical guidance supports mechanical prophylaxis with intermittent pneumatic compression devices (Gould et al., 2012). Those devices only protect a patient when they are on the legs, correctly sized and placed, connected, and running, ideally for most of the time the patient is in bed. On 5 West, a 32-bed general surgical unit, hospital policy states that ordered compression devices are to be applied and functioning whenever the patient is in bed or chair, removed only for ambulation, bathing, or skin checks.

How What Happens Was Measured

Method: direct observation. With the nurse manager's approval, I and a second observer, a nurse from the unit's practice council, made unannounced observation rounds at three random times each day, one on each shift, for 10 consecutive days in January. At each round, we observed every patient with an active order for compression devices who was in bed or chair. Each observation was classified as correct, meaning sleeves on both legs, properly positioned, tubing connected, and the pump running without an alarm, or as a failure, with the type of failure recorded. We did not change anything or alert staff during observation, and we did not record patient or staff names. To check agreement, both observers independently classified the same 20 observations on day 1; they agreed on 19.

The Gap, as a Number

Across 10 days, we made 126 observations of patients with active orders who were in bed or chair. The devices were correctly applied and functioning in 60 of 126, or 48%. The failures fell into five groups: sleeves not on the patient at all, 31 observations; sleeves on but pump turned off or unplugged, 17; sleeves on only one leg, 8; tubing disconnected or kinked, 6; sleeves positioned incorrectly, such as around the ankles, 4. Correct use was highest on the day shift, 58%, and lowest on the night shift, 37%, and lower on the first postoperative day than later. These findings are similar in character to published observations, which found that compression devices were often not applied or not working as intended in hospitalized patients (Elpern et al., 2013).

Why the Gap Exists Here

Short interviews with eight nurses and four nursing assistants, and observation of the equipment, suggested several reasons. The sleeves are removed for ambulation and bathing and often not replaced. Patients find them hot and noisy at night and ask to have them off. The pumps' alarms are silenced rather than troubleshot. There are fewer pumps than beds, so on busy days a pump taken to a new admission is not replaced for the original patient. And the electronic record asks nurses to document "SCDs on" once a shift, which does not show whether they stayed on. Several staff said they had never been shown how to troubleshoot the pump's alarms, and none could say where spare sleeves in each size were kept.

What the Gap Means for the Project

The gap is large enough to matter and specific enough to act on. A project that aims to increase correct use from 48% to 75% on this unit within six weeks would be meaningful and measurable with the same observation method. The failure types point to specific interventions: replacing sleeves after ambulation as part of the nursing assistant's routine, patient education on why the device matters, and a pump inventory to fix the shortage. The same observation method, at the same times and with the same observers, will be used after implementation, because a different method would produce a different number regardless of any change in practice, and a stable method is what allows a before-and-after comparison to be read as a test of change (Langley et al., 2009).

Limits of the Measurement

Ten days is a short window, and January census may differ from other months. Observers may have been noticed on some rounds despite being unannounced, which would tend to make the correct-use rate look higher than it usually is. The observation does not measure how long devices stayed on between rounds. These limits are stated so that the baseline is read as an estimate, not a precise figure. Even allowing for them, a correct-use rate below half on every shift is far enough from the policy standard that the gap is not in doubt, only its exact size.

References

Elpern, E., Killeen, K., Patel, G., & Senecal, P. A. (2013). The application of intermittent pneumatic compression devices for thromboprophylaxis: An observational study found frequent errors in the application of these mechanical devices in ICUs. American Journal of Nursing, 113(4), 30-36. https://doi.org/10.1097/01.NAJ.0000428736.48428.10

Gould, M. K., Garcia, D. A., Wren, S. M., Karanicolas, P. J., Arcelus, J. I., Heit, J. A., & Samama, C. M. (2012). Prevention of VTE in nonorthopedic surgical patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2 Suppl.), e227S-e277S. https://doi.org/10.1378/chest.11-2297

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.