Nurses at the National Neuroscience Institute (NNI) and Singapore General Hospital (SGH) are leading a project to prevent stroke patients with limited mobility from developing a potentially fatal condition caused by blood clots in leg veins.

Deep Vein Thrombosis (DVT) is a blood clot that occurs within a deep vein, usually in the leg. Part of the blood clot can break free and travel up to the lungs, where it can lodge and form a pulmonary embolism (PE). DVT and PE are also known as Venous Thromboembolism (VTE).

Without any intervention, approximately 10 to 50 per cent of acute stroke patients run the risk of VTE, which can have serious consequences. "VTE can be fatal and survivors may experience a long-term condition called post-thrombotic syndrome (PTS). This can cause pain, swelling and chronic wounds in the leg that has the clot," said project lead Dr Ng Wai May, Advanced Practice Nurse and Deputy Director of Nursing, NNI.

"The good news is that VTE is mostly preventable in stroke patients if they are put on an intermittent pneumatic compression (IPC) device," she added. This improves blood circulation, helping to keep DVT at bay.

Closing the gap

Dr Ng noted that before the project started in 2018, many acute stroke patients at SGH were not prescribed the preventive treatment, even though the technique is simple, affordable, and non-invasive. The project addressed this shortfall by empowering nurses to identify stroke patients who would benefit from IPC and start the preventive treatment without having to wait for a doctor’s order.

"Nurses at SGH’s stroke unit received training to understand the dangers of VTE and the importance of the compression device. Medical Informatics also played a role in the project’s success, as prompts were included in the patient care management system to remind nurses to identify at-risk patients and to start them on the IPC device," said Dr Ng.

If a stroke patient has weakness in his legs and is unable to walk, he should be put on the compression device. If patients are not suitable for the device, such as those with leg fractures, the nurses will highlight this to the doctors and other preventive measures will be considered.

Now, because of the project, 85 per cent of suitable patients at SGH’s stroke unit are placed on the IPC device, compared to just 15 per cent previously. This has resulted in a reduction in the number of stroke patients who suffer from VTE — from one to two per month before the project to one in nine months.

The team was recognised for their achievement at the Ministry of Health’s Value Driven Care Conference 2019.

The project can also be replicated at other stroke units to keep patients safe from VTE. Dr Ng has shared details of the project with several other healthcare facilities so that more patients and families can avoid the pain and grief caused by VTE.