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Evidence based practice for dvt prophylaxis - power point


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Evidence based practice for dvt prophylaxis - power point

  1. 1. Evidence-Based Practice and Innovation for DVT Prophylaxis for Hospitalized Patients Rafie Davidov University of Wisconsin – Green Bay Spring – 2010
  2. 2. DVT Prophylaxis for hospitalized patients: <ul><li>For hospitalized patients, is the use of subcutaneously – administered Lovenox more effective in DVT prevention compared to using sequential compression devices (SCDs) alone? </li></ul>
  3. 3. Review of Evidence-Based Practice Sources: <ul><li>Source 1: Meta-analysis. </li></ul><ul><li>Source 2: Randomized, controlled trial. </li></ul><ul><li>Source 3: Recommendations from the seventh ACCP conference. </li></ul><ul><li>Source 4: Pathophysiology. </li></ul>
  4. 4. Evidence – Based Practice Sources: Source 1 <ul><li>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. </li></ul><ul><li>A meta-analysis of 10 randomized controlled trials. </li></ul><ul><li>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. </li></ul>
  5. 5. Evidence-Based Sources: Source 2 <ul><li>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. </li></ul><ul><li>Assessor-blind, randomized, controlled trial. </li></ul><ul><li>Results: Lovenox found to be more effective in DVT prophylaxis than SCDs. </li></ul>
  6. 6. Evidence-Based Sources: Source 3 <ul><li>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. </li></ul><ul><li>Recommendations from the seventh conference of ACCP (American College of Chest Physicians). </li></ul><ul><li>Recommendations: For DVT prophylaxis, the use of both a heparin agent and elastic compression stockings is recommended, unless contraindicated. </li></ul>
  7. 7. Evidence-Based Sources: Source 4 <ul><li>Springhouse Corporation. (2001). Handbook of pathophysiology. Springhouse, PA: Springhouse Corporation. </li></ul><ul><li>Type of source: a pathophysiology book. </li></ul><ul><li>Recommendations: the use of heparin agents is recommended for DVT prophylaxis over compression stockings unless contraindicated. </li></ul>
  8. 8. Suggested Innovation Based on the Reviewed Evidence <ul><li>The innovation consists in developing individualized DVT prophylaxis regimens for all inpatients upon admission. </li></ul><ul><li>Individual patient history, risk factors, and preferences will be considered. </li></ul><ul><li>The plans will be based on the collaborative efforts of nurses and physicians. </li></ul><ul><li>Patient and family education will be a key factor in developing and carrying out every individualized DVT prophylaxis plan. </li></ul><ul><li>Kotter’s Phases of Change Model will be used for implementation of the innovation. </li></ul>
  9. 9. Implementation Process <ul><li>Establish Urgency: an in-service for nurses and physicians to present facts of current DVT prophylaxis practice. </li></ul><ul><li>Create Coalition: a core team will be created to facilitate implementation of the innovation. </li></ul><ul><li>Develop Vision: Present information on how the change would affect patient satisfaction, perception of the hospital, quality of care, and competitors. Vision statement. </li></ul><ul><li>Communicate vision : Develop a PowerPoint presentation to deliver info to all nurses and physicians. </li></ul>
  10. 10. Implementation Process (Continued) <ul><li>Empower Action: Core team develops a DVT risk assessment tools and trains RNs in using the tool. </li></ul><ul><li>Generate Short-Term Wins : Present information bi-monthly on current DVT rates and compare to pre-intervention. </li></ul><ul><li>Consolidate Gains, Produce More : In 3 months, re-assess RNs’ knowledge of DVT prophylaxis policy, and intervene to correct problems. </li></ul><ul><li>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. </li></ul>