Master of Science

Nursing Leadership & Administration

May 2016


VTE PREVENTION PROGRAM: AN EVIDENCE- BASED PROPOSAL

Master of Science
Nursing Leadership & Administration
By:
Manal I. Fallatah
M.S.N, RN
May 2016

VTE
Incidence
VTE
knowle
dge

Recom
mendat
ions

Cost

Background of Clinical Problem and Setting: Pathology.

Approximatel
y 300,000 of
these
patients die.

VTE is the
most
preventable
cause of
hospital
related
death.

VTE is a
common
disease that
includes both
DVT and PE.

https://www.youtube.com/watch?v=gYm9
MBZFaic

Background: History of the treatment

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Background: History of the treatment

Before
discovering
Anticoagulants
:
Bed rest for 6
first. half of
months

the 20th
century

The first
half of 20

Simplification of
Anticoagulants.
Ambulatory
treatment.
End of bed-rest
doctrine.

The second
half of 20

Background of Clinical Problem and Setting

Acute
medica
l
infectio
n.

At risk
for VTE

Hospitalize
d patients
with acute
medical
illness.

Aage
s
>75.

Healthy
young
adults who
have major
surgery. sustain multiple
trauma, are immobile
for a lengthy period,
or have
hypercoagulable
disorders.

Clinical Problem
Current
Practice

VTE
Prevention
Not
effective
risk
assessment
tool

100%
depending
on Chemical
prophylaxis

No patient
Education
Program

King Abdulaziz University Hospital

Jeddah, Makkah Almokarramah, KSA
Serve the community by providing patient care services at all levels,
the environment for education and training of health professionals and
promoting research.

Question
P

Adult, hospitalized, orthopaedic, surgical patients in a KAHU

Nurses must: utilize a VTE risk assessment tool for every

patient undergoing an orthopaedic procedure
provide education to patients on VTE thromboprophylaxis to
I
patients.
actively engage in promoting early mobilization and activity for
all patients to reduce VTE.
The current standard of care, which does not include any
C
patient assessment or education
.

Within One Year of Program Implementation:

40% increase in using the VTE assessment tool
O 50% increase in patient knowledge using Teach Back prior to discharge.
40% decrease in diagnosed DVT/PE
One year to implement with evaluations at 6 months and 1 year
and then annually
T

By the end of the EBP the learners

Will be

Use the most

Able effective risk
to assessment tool
Effective educate
Able patients on
to prophylaxis use
Effective educate
Able patients on self
to management.

Theoretical Framework for the Evidence-Based

Change

Change Theory Overview

Smart Advanced Online Searches

VTE
Preventi
on

VTE
Prophyla
xis

Key
word
s

VTE
Guidelin
es

Patient
Educatio
n

Prophyla
xis
Educatio
n

Search mechanism
7 systematic
reviews
1 opinion
based on
RCT.
1 guideline.
2 strong
reports.
4strong
single
studies.

53 Articles

15 Articles
included

Complete
research

Support
nursing
interventio
ns

39 Articles
excluded

Not
completed

Body of Evidence

Theme 1
Perform risk assessment using

effective tools.
Pretest Probability of DVT,
(DVTQOL).
AHRQ.

Theme 2
Educate patients on the use of

prescribed prophylaxis medications

Theme 3

Educate patients on self-

management to prevent VTE.

Theme 4
Applying AHRQ GUIDELINES.
.

Evidence-Based Change Description

Improve the
the
Improve
management plan
plan for
for
management
patients and
and will
will
patients
contribute
to
an
overall
contribute to an overall
understanding
understanding
(interdisciplinary) of
of the
the
(interdisciplinary)
promotion of
of evidence
evidence
promotion
based VTE
VTE prevention
prevention in
in
based
this population.
population.
this

Provide nurses
nurses with
with
Provide
comprehensive, evidenceevidencecomprehensive,
based strategies,
strategies,
based
interventions,
practices,
and
interventions, practices, and
major outcomes
outcomes that
that must
must
major
be considered.
considered.
be

AHRQ has
has
AHRQ
guidelines
guidelines
from the
the A
AC
C
from
CP
P
C

Aim to
to optimize
optimize patient-important
patient-important
Aim
health outcomes
outcomes and
and the
the
health
processes of
of care
care for
for patients
patients who
who
processes
have experienced
experienced or
or are
are at
at risk
risk for
for
have
thrombotic events.
events. Finally,
Finally, it
it aims
aims
thrombotic
to discuss
discuss prophylaxis
prophylaxis of
of venous
venous
to
thromboembolism in
in patients
patients
thromboembolism
undergoing orthopedic
orthopedic surgery,
surgery,
undergoing
including total
total hip
hip arthroplasty,
arthroplasty,
including
total knee
knee arthroplasty,
arthroplasty, hip
hip
total
fracture surgery,
surgery, below-knee
below-knee
fracture
injuries, and
and arthroscopic
arthroscopic
injuries,
procedures.
procedures.

Implementation of
AHRQ guidelines.
guidelines.
AHRQ

Offer guidance
guidance for
for many
many common
common
Offer
anticoagulation-related
anticoagulation-related
management problems
problems
management

Aim to
to update
update evidence-based
evidence-based
Aim
recommendations for
for the
the use
use of
of
recommendations
anticoagulant treatment
treatment for
for the
the
anticoagulant
management of
of thromboembolic
thromboembolic
management
conditions.
conditions.
Provide evidence-based
evidence-based
Provide
recommendations for
for practice,
practice,
recommendations
education, and
and policy,
policy, for
for both
both
education,
pharmacologic and
and nonnonpharmacologic
pharmacological prophylaxis
prophylaxis in
in
pharmacological
the settings
settings for
for orthopedic
orthopedic
the
patients.
patients.

Education Plan

Implementation Plan
Meeting room
One hour
Nurse leader
Nurse educator

Overview of educational/leadership
theory/framework or other theory

Educating at-risk patients on

prophylaxis use
Educating patients on selfmanagement after discharge
Nurses will be taught how to use
the VTE Assessment Tool.
Nurses will be taught the
importance of early mobility
Nurses will be taught how to use
teach-back in educating their
patients .

R
n eo
p
edext er
u en a t
ca s i io
ti ve
on

op P
ex er o st
ed te at
u c n s i on
at ive
io
n

Include overview of educational/leadership

theory/framework or other theory

Repeat
ed
Initiate
d

yearly
For entry level nurses

Translation to Clinical Setting and

Implementation Plan

of ti
ck va
la oti .
n
m o

lack of
awarene
ss.

fa L ac
m k
i o
ty lia f
. ri

Weekly
reminder
s.

VTE
preventi
on
guidelin
es.

Weekly
meeting
and
educatio
n.

Resources needed

We

Surgi
Surgi
cal
cal
Unit
Unit
man
man
ager
ager
ss

Need

Surgi
Surgi
cal &
&
cal
Clini
Clini
cal
cal
nurs
nurs
e
e
staff
staff

Those

Surgi
Surgi
cal
cal
Nurs
Nurs
e
e
Educ
Educ
ators
ators

Phar
Phar
mac
mac
yy
men
men
tors
tors
Physi
Physi
cal
cal
ther
ther
apie
apie
ss
As
A
multidisciplinary
team

Nursi
Nursi
ng
ng
direc
direc
tors
tors

Healthcare
quality
Cost, death
percentage,
and VTE
incidence.
Benefits

40%
increase in
using the
VTE
assessmen
t tool

40%
decrease
in
diagnose
d DVT/PE

Over
a
year

50% increase
in patient
knowledge
using Teach
Back prior to
discharge.

Evaluation Plan

Sustain the Gain

A project leader must check for any gaps that may lead to
unsuccessful outcomes during the implementation plan.
If the costs of implementing the program are higher than
expected, and the desired outcomes seem to be difficult to
achieve, the project may be stopped.
Feasibility of the project will be studied again.
The options: meeting with the team members to discuss the
problem and potential solutions.
listening to everyones opinions and recommendations.
If the options are not deemed feasible the project will be
discontinued.
The project leader must be aware of the importance of
feedback during the implementation process.
Effective feedback will enable leaders and team members to
identify factors that hinder the implementation process.

Sustaining change and

dissemination results

Weekly
meeting
s

telepho
ne calls

emails

positive

Final discussion
Nursing
Nursing
knowledge.
knowledge.

Nursing
Nursing
Practice.
Practice.

Role Of
Of the
the
Role
Masters
Masters
Prepared
Nurse
Prepared Nurse
As Change
Change
As
Agent And
And Role
Role
Agent
Model.
Model.

lead to
to patient
patient
lead
satisfaction
satisfaction
increase as
as well
well
increase
as
as

They provide
provide the
the
They
most current
current
most
practice for
for VTE
VTE
practice
prevention.
prevention.

S/he is
is
S/he
responsible to
to
responsible
start and
and lead
lead
start
this EBP
EBP
this
movement.
movement.

staff satisfaction
satisfaction
staff
increase.
increase.

Nurses will
will be
be
Nurses
qualified to
to
qualified
provide safe
safe and
and
provide
quality care
care to
to
quality
patients.
patients.

Nurse leaders
leaders
Nurse
must prove
prove that
that
must
they are
are well
well
they
prepared to
to make
make
prepared
the change.
change.
the

knowledge also
also
knowledge
increased.
increased.

They can
can
They
promote learning
learning
promote
and education.
education.
and

EBP must
must be
be
EBP
successfully
successfully
adopted
and
adopted and
sustained by
by
sustained
leaders.
leaders.

Increase the
the
Increase
tendency to
to get
get
tendency
more
updated
more updated
knowledge.
knowledge.

There will
will be
be aa
There
noticeable
noticeable
decrease in
in
decrease
diagnosed
diagnosed
DVT/PE.
DVT/PE.

Nurse leader
leader has
has
Nurse
the keys
keys to
to
the
discovering and
and
discovering
closing by
by their
their
closing
knowledge.
knowledge.

Nurses can
can
Nurses
identify and
and
identify
bridge
the
gaps
bridge the gaps
between what
what is
is
between
and what
what should
should
and
be.
be.
Nurses can
can focus
focus
Nurses
more on
on their
their
more
work from
from the
the
work
lens of
of quality
quality
lens
and safety.
safety.
and

Skills get
get
Skills
increased.
increased.

nurses will
will be
be
nurses
able to
to meet
meet the
the
able
challenge
of
challenge of
improving
improving
healthcare.
healthcare.

They are
are able
able to
to
They
convert this
this
convert
knowledge
into
knowledge into
practice to
to get
get
practice
the real
real
the
outcomes
outcomes

Reflection