Best Practice

• Ensure correct sizes for SCDs• Ensure SCDs are properly in place and machine is working properly• Assess skin condition when you remove/replace SCDs.• Remember KEEP SCD SLEEVES OFF THE FLOOR!!•Include patients/families in plan of care to improve compliance with SCDs

Abstract:

Effectiveness of patient and staff education in VTE prophylaxis 

Mallika.Patel, BSN, RN-BC & Diane Kuehnlenz MS, APNDepartment of Nursing, Advocate Lutheran General Hospital

P Adult patients undergoing surgical procedures who have mechanical venous thromboembolism (VTE) prophylaxis devices ordered.

I Patient/family education implemented following educating 7 Tower Surgical Care Unit nurses at Advocate Lutheran General Hospital.

C Usual application of SCDs(sequential compression device) and patient/family education.

O Wear time of mechanical prophylaxis device to minimum 20 hours per day post-surgery.

Introduction:• Venous thromboembolism (VTE) is a serious and often fatal disease affecting approximately 900,000 individuals in the United States each year • VTE comprises Deep venous thrombosis (DVT) and pulmonary embolus (PE) • Among patients discharged from U.S. hospitals, VTE was the second leading cause of medical complications and prolonged length of stay, and third leading cause of preventable mortality and excessive hospital charges • With appropriate prophylaxis, including chemical and/or mechanical, many of theses thromboembolic events can be prevented

 

This study intends to compare the wear time of SCDs in adult post surgical patients before and following the implementation of a VTE prophylaxis educational program on 7 Tower Surgical Care Unit. Outlined is the process of implementing the study intervention to improve compliance in VTE prophylaxis.

 Sample• Adult post surgical patients• Nursing staff on 7 Tower Surgical Care Unit at Advocate Lutheran General Hospital

Instruments• Pre and post survey of the education.• Bedside documentation tool for SCD wearing.

Measures• Pre and post test comparison using t-test.• Total wear time for mechanical prophylaxis will be analyzed by reading documentation.

 

References:

Summary of pertinent literature:

• When using SCD’s as VTE prevention measure, care is directed to ensure proper use and optimal adherence• VTE prophylaxis is often underused or inappropriately used• Nurses are in a pivotal role to prevent VTE. Hospital culture is changed as nurses become educated about VTE risk and prevention • Educated patients maintain better health and have fewer complications; as a result, they have fewer hospitalizations, emergency department visits, and clinic and physician visits

Timeline for duration of project (include expected start and completion dates).       Data collection to begin pending approval of the IRB        May 2011; IRB approval-obtain base line data regrind SCD wear time         June 2011; Implement Educational Program        July2011; Complete post intervention data collection. Data analysis       August 2011; Write up of research report

Why important for healthcare?Recently, a marked increase has occurred in federal and national efforts to raise awareness and acknowledge the need for VTE prevention and an attempt to improve VTE prophylaxis in U.S. hospitals.

• The agency for Healthcare and Research quality (AHRQ) identifies VTE as a hospital-level Patient Safety Indicator (PSI). PSI can be used by hospital to identify complications that may represent patient safety event • According to The center for Medicare and Medicaid Services (CMS),VTE is considered “never events”. In order to improve patient outcomes the CMS has gone to pay for performance for hospital acquired VTE in which the hospital will not be reimbursed for the cost of treating these DVT and PE• The Surgical Care Improvement Project (SCIP) is a national quality partnership of organizations focused on improving surgical care by significantly reducing surgical complications

 

Methods:

.

Patient education handout: Prevent Blood Clots in the Hospital

What You Need To Know! You may be at risk to develop a blood clot in any part of your body after surgery. Blood clots may develop because the blood is not moving well when you are in bed. When you

are up and walking, your body has better circulation, which helps minimize your risk to develop blood clots.

 Your doctor may want you to use other ways to prevent blood clots. These may include:

SCDs (Sequential Compression Devices) and Foot pumps * These pumps are connected to special sleeves or inflation pads that wrap around your lower legs or feet. * These devices help with blood circulation in the feet and legs by mimicking the natural effects of walking. * The sleeves can be removed by a health care person for therapy or leg care. * The sleeves will need to be put back on after the therapy or leg care is done.Shots to prevent blood clots * Shots may be given to prevent blood clots. * The shots are given one to two times each day in the belly with a very small needle.Things you can do to help prevent blood clots while you are in the hospital: * Avoid crossing your legs. * Keep the SCDs/foot sleeves on while you are in bed. * If the doctor says to get up, then you do not have to stay in bed. Ask for help from your nurse to get up. * Change your position often, do not sit or stand for over 1 hour at a time. * It is best to be out of bed as much as you can; ask for help to disconnect the sleeves and get up. * Walk in the room and hallways when the doctor says it is OK. * Drink fluids when the doctor says it is OK.Remember to tell your Nurse if:The SCD/foot sleeves are not on or the pump is not working You feel pain in your legs or calf.You suddenly feel that you are short of breath and have pain with breathing. These may be signs of a blood clot.

Let your nurse or doctor know if you have any questions!

American Public Health Association. (2004). Deep vein thrombosis: raising awareness to protect patient lives. http://www.apha.org/NR/rdonlyres/A209F84A-7C0E-4761-9ECF-61D22E1E11F7/0/DVT_White_Paper.pdfBeck D. (2006) Venous Thromboembolism Prophylaxis: Implications for Medical-Surgical Nurses. Medsurg Nursing, Vol. 15/No 5.Brendle, T. A. (2007). Surgical Care Improvement Project and the perioperative nurse’s role. AORN Journal, 86(1), 94–101Center for Medicare & Medicaid Services. (2008). Hospital Inpatient Quality Reporting Program. http://www.cms.gov/HospitalQualityInits/08_HospitalRHQDAPU.aspCollins, Renea: MacLellan, Lorna; Gibbs, Harry; MacLellan, Donald and Fletcher, John. (2010). Venous Thromboembolism Prophylaxis: The Role of the Nurse in Changing Practice and Saving Lives [online]. Australian Journal of Advanced Nursing Mar/May; 27(3): 83-89.Comerota AJ, Katz ML, White JV. (1992). Why does prophylaxis with external pneumatic compression for deep vein thrombosis fail? Am J Surg; 164(3):265-8.Geerts WH, Bergqvist D, Pineo GF, et al.(2008). Prevention of venous thromboembolism. American College of Chest Physicians Evidence-Based Practice Guidelines (8th edition).Chest;133:381S-453S.Graduated compression stockings for the prevention of post-operative venous thromboembolism. Evidence based information sheets for health professionals. Best Practice, 2008; 12(4).Heit JA, Cohen AT, Anderson FAJ, on behalf of the VTE Impact Assessment Group. (2005). Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. ASH Annual Meeting Abstracts.106:910.

Contraindications to SCDs

• Gangrene• Severe ischemic vascular disease• Severe lover extremity edema (lymphedema)• Severe dermatitis• Suspected existing DVT

Initiate SCDs immediately after post-operative phase, unless it is

contraindicated.

This project will engage Advocate Lutheran General Hospital 7 Tower RNs in a nursing research study.

Teaching the nurses will • Emphasize the role of SCDs in prevention of VTE• Teach the importance of VTE prophylaxis in achieving our KRA• Give staff tools to do their own patient teaching

Teaching patients will• Allow patients to participate in their own care• Give patients information regarding their own risk for VTE and ways to prevent complications• Encourage relationship building between the patient and nurse * Will improve patient’s health outcomes.

NON-COMPLIANCE FOR WEARING SCD :

- Not knowing the benefits of having mechanical prophylaxis.- Patients found mechanical prophylaxis intolerable/ quite uncomfortable- For some patients they have difficulty with sleeping with SCDs- Patients may found that they are connected to device all the time and they do not have freedom without someone helping.- Non compliance with mechanical prophylaxis use is also due to need for device connection to an external power source.- Nursing staff and patients were not vigilant in reconnecting device after disconnecting for a various reasons.