A Quality Improvement Project to Assess and Improve the Recognition of Compartment Syndrome by Nurses in the Orthopedic Department

Abstract

Delayed recognition of compartment syndrome can result in devastating consequences such as the need for amputation or even death. Nurses are at the frontline of patient care in the orthopedic department and it is essential that they have a high index of suspicion for compartment syndrome. In this publication we describe an easily replicable project to assess and improve the understanding of the condition by nurses on trauma wards. Our project involved a questionnaire to assess the ability of nurses to recognise the key clinical features of compartment syndrome. This initial questionnaire was followed by a one-week teaching programme within the department, after which the questionnaire was repeated. Our results demonstrate that nursing staff place a disproportionate emphasis on neurovascular compromise in recognising the condition. Only just over one half (11/21) could correctly identify 'pain out of proportion to the associated injury' as the key clinical feature. Unlike pain, neurovascular compromise is a late feature of compartment syndrome and overstating its importance may potentially contribute to delayed diagnosis. Our targeted educational week dramatically improved the number of correct responses. One month after the teaching week, 83% (19/23) of nurses correctly identified pain as the most important feature in compartment syndrome. We hope that improved knowledge of compartment syndrome by nurses will help to reduce delayed recognition and adverse outcomes.