EVIDENCE BASED PRACTICE COMMITTEE MODELING EVIDENCE BASED PRACTICE: SEQUENTIAL COMPRESSION DEVICES

1
EVIDENCE BASED PRACTICE COMMITTEE MODELING
EVIDENCE BASED PRACTICE SEQUENTIAL COMPRESSION
DEVICES

• Ann Laramee APRN MS
• Martha Jo Hebert RN
• Hollie Shaner-McRae DNP RN FAAN
• Linda Gruppi RN MSN

2
Venous Thromboembolism

• Deep Vein Thrombosis blood clot in the deep
  veins of legs that can travel to heart and lungs
  causing a Pulmonary Embolism
• Can be fatal, cause disability
• Accounts for 10 of hospital deaths
• Incidence of hospital acquired is 10-40 for med
  and gen surg, 40-60 for major orthopedic
• Post operative VTE 9.3/1000 discharges

3
(No Transcript)
4

• VTE The Most Common Preventable
  In-Hospital Death

5
Risk Factors for VTE

• Advancing age
• Immobility
• Obesity
• Pregnancy or post partum
• Central Venous catheter
• Estrogen based therapy
• Smoking

• Family history
• Trauma
• Recent surgery
• Medical conditions
• MI, CHF, stroke
• Lung disease
• Cancer
• Sepsis
• Hospitalization

6
Prevention of VTE

• Non-Pharmacological
• Graduated Compression Stockings
• Intermittent Pneumatic compression devices(SCDs)
• Foot pumps
• IVC filters

• Pharmacological
• Unfractionated Heparin
• Low Molecular Weight Heparin
• Fondaparinux

7
Fletcher Allen Health Care

• Observation audit October 2007 38 use of SCD
  (n20/53)
• SCD compression sleeves 2007 - 2008 averaged
  1100 pairs/month
• VTE diagnosis July 2008 June 2009
• - 195 cases
• - Incidence 8.9/1000 discharges
• SCIP VTE prophylaxis overall compliance July
  2008 July 2009
• - Ordered 95 (n201/211)
• - Received 96 (n200/209)
• Issues
• Variation in practice with ordering
• Failure to follow policy
• Knowledge deficit of appropriate use
• Lack of patient education

8
FAHC Nursing Evidence-Based Practice Model
State the problem Form a team
Evaluate outcomes
Check research
Adopt practice change
Synthesize Evidence
Colleagues Helping Achieve Model Practice
. Pilot the change
Adopted from 2001 Iowa Model
9
(No Transcript)
10
Stetlers Levels of Evidence
11
Summary of Literature

• Systematic Review
• General recommendations
• Patients at high risk of bleeding
• Patients with multiple risk factors as adjunct
  therapy
• Used properly!! Compliance!!
• Lack of evidence for specifics
• Initiation when to start?
• Duration
• Type

12
(No Transcript)
13
Next Steps

• Multidisciplinary Team
• Agree on the Systematic Review
• Revise and Reinstall SCD Policy
• Select Outcomes to be Achieved
• Pilot the change on a Surgical and Medical Unit

14
Next Steps

• Collect Unit Baseline Data, Evaluate Process
  Outcomes, Modify the Practice
• Institute the Change in Practice Hospital wide?
• Monitor and Analyze Structure, Process, and
  Outcome Data
• Disseminate Results

15
Summary

• The Iowa EBP Model can be effective
• The EBP Committee is a resource and champion for
  quality changes in nursing
• SCDs are an effective prophylaxis for the
  appropriate patients
• Compliance is essential