Evidence based practice for dvt prophylaxis - power point
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  • 1. Evidence-Based Practice and Innovation for DVT Prophylaxis for Hospitalized Patients Rafie Davidov University of Wisconsin – Green Bay Spring – 2010
  • 2. DVT Prophylaxis for hospitalized patients:
    • For hospitalized patients, is the use of subcutaneously – administered Lovenox more effective in DVT prevention compared to using sequential compression devices (SCDs) alone?
  • 3. Review of Evidence-Based Practice Sources:
    • Source 1: Meta-analysis.
    • Source 2: Randomized, controlled trial.
    • Source 3: Recommendations from the seventh ACCP conference.
    • Source 4: Pathophysiology.
  • 4. Evidence – Based Practice Sources: Source 1
    • Sjalander, A., Jansson, J-H., Bergqvist, D., Eriksson, H., Carlberg, B., & Svensson. P. (2007). Efficacy and safety of anticoagulant prophylaxis to prevent venous thromboembolism in acutely ill medical inpatients: a meta-analysis. Journal of Internal Medicine, 263. 52-60.
    • A meta-analysis of 10 randomized controlled trials.
    • Results: Lovenox prophylaxis prevents about 50% of expected venous thrombo-embolisms. Elevated risk of bleeding, although not significant. Death not significantly affected by Lovenox therapy.
  • 5. Evidence-Based Sources: Source 2
    • Camporese, G., Bernardi, E., Prandoni, P., Noventa, F., Verlato, F., Simioni, P., et al. (2008). Low-molecular-weight heparin versus compression stockings for thrmoboprophylaxis after knee arthroscopy: a randomized trial. Annals of Internal Medicine, 149 (2), 73-82.
    • Assessor-blind, randomized, controlled trial.
    • Results: Lovenox found to be more effective in DVT prophylaxis than SCDs.
  • 6. Evidence-Based Sources: Source 3
    • Buller, H., Angelli, G., Hull, R., Hyers, T., Prins, M. & Raskob, G. (2004). Antithrombotic therapy for venous thromboembolic disease: The seventh ACCP conference on antithrombotic and thrombolitic therapy. Chest Journal, 126 (3), 401S-428S.
    • Recommendations from the seventh conference of ACCP (American College of Chest Physicians).
    • Recommendations: For DVT prophylaxis, the use of both a heparin agent and elastic compression stockings is recommended, unless contraindicated.
  • 7. Evidence-Based Sources: Source 4
    • Springhouse Corporation. (2001). Handbook of pathophysiology. Springhouse, PA: Springhouse Corporation.
    • Type of source: a pathophysiology book.
    • Recommendations: the use of heparin agents is recommended for DVT prophylaxis over compression stockings unless contraindicated.
  • 8. Suggested Innovation Based on the Reviewed Evidence
    • The innovation consists in developing individualized DVT prophylaxis regimens for all inpatients upon admission.
    • Individual patient history, risk factors, and preferences will be considered.
    • The plans will be based on the collaborative efforts of nurses and physicians.
    • Patient and family education will be a key factor in developing and carrying out every individualized DVT prophylaxis plan.
    • Kotter’s Phases of Change Model will be used for implementation of the innovation.
  • 9. Implementation Process
    • Establish Urgency: an in-service for nurses and physicians to present facts of current DVT prophylaxis practice.
    • Create Coalition: a core team will be created to facilitate implementation of the innovation.
    • Develop Vision: Present information on how the change would affect patient satisfaction, perception of the hospital, quality of care, and competitors. Vision statement.
    • Communicate vision : Develop a PowerPoint presentation to deliver info to all nurses and physicians.
  • 10. Implementation Process (Continued)
    • Empower Action: Core team develops a DVT risk assessment tools and trains RNs in using the tool.
    • Generate Short-Term Wins : Present information bi-monthly on current DVT rates and compare to pre-intervention.
    • Consolidate Gains, Produce More : In 3 months, re-assess RNs’ knowledge of DVT prophylaxis policy, and intervene to correct problems.
    • Anchor Approaches : Core team will audit implementation of innovation bi-weekly, then monthly. Results will be discussed with staff monthly for the first 6 months.