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

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. Venous Thromboembolism.

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

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  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. VTE The Most Common Preventable In-Hospital Death

  4. 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 Risk Factors for VTE

  5. Non-Pharmacological Graduated Compression Stockings Intermittent Pneumatic compression devices(SCDs) Foot pumps IVC filters Pharmacological Unfractionated Heparin Low Molecular Weight Heparin Fondaparinux Prevention of VTE

  6. Fletcher Allen Health Care • Observation audit October 2007: 38% use of SCD (n=20/53) • 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% (n=201/211) - Received 96% (n=200/209) • Issues • Variation in practice with ordering • Failure to follow policy • Knowledge deficit of appropriate use • Lack of patient education

  7. 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

  8. Stetler’s Levels of Evidence

  9. 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

  10. 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

  11. 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

  12. 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

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