Increasing awareness of compartment syndrome among orthopedic nurses and trauma nurse practitioners at a district general hospital: a complete audit loop

Abstract

Background: Acute compartment syndrome (ACS) is a surgical emergency defined by a critical increase in pressure within a closed osteofascial compartment requiring prompt diagnosis treatment via fasciotomy and decompression of the affected compartment. A critical factor for a poor outcome following ACS is a delay in the initial recognition and subsequent diagnosis. Orthopedic nurses (ONs) are usually the first port of call to see patients at risk of developing ACS prior to escalation. The aim of this audit project was to evaluate the baseline knowledge of the nursing staff for ACS, aiming to improve awareness and early diagnosis of the condition. Methods: A 6-point pre-course questionnaire focusing on the clinical diagnosis of ACS, early signs and symptoms, immediate interventions and complications of a delay in diagnosis was filled out by ONs to assess baseline knowledge. Following a targeted lecture, the questionnaire was repeated. A ward-based protocol was introduced for quick reference, highlighting an early escalation plan following recognition of ACS. A follow-up questionnaire was filled at 4 months.Results: A majority of the nurses involved in this audit had little or no prior clinical experience in the management of patients with ACS. Following the interventions, all staff could define ACS. Tibial shaft fractures were correctly identified as high risk for ACS (89% post course; 100% final questionnaire). Pain out of proportion, as well as pain on passive stretch, was correctly identified as the most important defining symptom (100% post course; 93% final questionnaire). There was variability in the immediate response following a diagnosis of ACS, and nurses were less inclined to perform a physical intervention (splitting cast – 43%) without prior medical review. Conclusion: Our audit highlights that simple, lecture-based interventions alongside printed ward-based protocols proved to be effective interventions. The audit emphasizes the need for continuous teaching and training of nurses to improve awareness and early diagnosis of ACS.