Más contenido relacionado
La actualidad más candente (9)
Similar a Critical Appraisal (20)
Critical Appraisal
- 2.
INTERVENTIONS FOR DECREASING POST OP VTE 2
Critical Appraisal
Introduction
Venous thromboembolism complications or VTEs are exceedingly common among
postoperative patients in the hospital. VTEs can take many different forms such as a deep vein
thrombosis or a pulmonary embolism. Most postoperative patients choose to delay and limit
mobilization due to their postoperative pain, but doing so may increase and predispose them to a
greater risk for developing a VTE. Regardless of the specific form they come in, they are the
leading cause of morbidity and mortality in the United States with incidences as common as, 117
per 100,000 postoperative patients (Cassidy, Rosenkranz & McAneny, 2014). For having such a
high rate of occurrence it brings about the question, what interventions, as opposed to receiving
the standard of care, would decrease the likelihood of developing postoperative venous
thromboembolisms? These interventions are important to discover and implement in the nursing
practice because they would greatly decrease the likelihood of patients developing any type of
VTE. Based on the article by Michael R. Cassidy, Pamela Rosenkranz & McAneny, Reducing
Postoperative Venous Thromboembolism Complications with a Standardized RiskStratified
Prophylaxis Protocol and Mobilization Program, the interventions to decrease the likelihood of
postoperative patients developing VTEs is to implement a standardized protocol for assessing a
patient's individualized risk for developing a VTE along with implementing an early
mobilization program after surgery (Cassidy et al., 2014).
PICO Question
P: Postoperative patients
I: Risk stratified prophylaxis protocol and early mobilization
- 4.
INTERVENTIONS FOR DECREASING POST OP VTE 4
as lowest, low, moderate, high, and highest. After the patient's score was calculated, the data
was entered into the hospital’s computer system which was designed to require that the surgeons
implement and construct an order for all postoperative patients to receive their standardized
prophylaxis protocol. However, the surgeon was still able to decline VTE prophylaxis protocol
implementation if the risk of another complication outweighed the risk for developing a VTE.
The study also included a standardized postoperative mobilization program which required the
nurses to get each patient out of bed, sitting in a chair, or walking, starting with the day of
surgery, at least 3 times daily. In which case, early mobilization was highly encouraged
throughout this entire study (Cassidy et al., 2014).
Study Purpose
The purpose of this study was to put into action and to determine the effectiveness of a
standardized VTE risk screening and intervention protocol such as an early mobilization program
for reducing the likelihood of patients developing any form of a postoperative venous
thromboembolism complication.
Sample
Before the implementation of the Caprini Scoring System and the early mobilization
program, the incidences of DVTs at the Boston Medical Center were recoded as 1.9% of 1,569
patients. After implementation of the two part VTE prevention program, the DVT complications
decreased to 0.3% of 1,323 patients. As far as PE incidences, before implementation of the
program, PE incidences were recorded as 1.1% of 1,569 patients, but decreased to 0.5% of 1,323
patients (Cassidy et al., 2014).
Major Study Findings
- 5.
INTERVENTIONS FOR DECREASING POST OP VTE 5
Before implementing the program, the hospital's baseline of care for postoperative
patients was assessed by observing the mobilization practices 3 times daily. Clinical staff
observed and recorded weather the patients were in bed, sitting in a chair, or walking at the time
that they visited the patient. The clinical staff found that there was little to no VTE prevention
requirements or guidelines before the study was implemented and carried out. Postoperative
patients generally stayed in bed longer than desired putting them at a higher risk to develop a
VTE. At times there may have been mobilization orders, but they were either too vague,
forgotten, or even non existent. Before the program there was also no patient specific and
individualized risk screening for VTEs, there were no electronic reminders in the computer’s
charting system about implementing a VTE prophylaxis, and there was no system like the
Caprini System being used to guide medical decisions and interventions. The study found that
there was a great compliance rate with the program and prophylaxis protocol that had been
created. Overall, the study found that with implementation of standardized patient specific VTE
screening and an early mobilization program the incidences of postoperative patients developing
a VTE significantly decreased (Cassidy et al., 2014).
Limitations & Strengths
The research article brought to question a few limitations in the study. The study only
captured a representative sample of patients, those being solely the postoperative patients, rather
than including all general hospitalized patients. In that case, a randomized trial wasn’t carried out
using the Caprini Scoring System or early mobilization interventions since that specific
exclusion criteria was in place. There may also have been some bias because different health
systems and hospitals may possess higher levels of technology that can help them better visualize
