Testing the effect of a targeted intervention on nurses' compliance with "best practice" mechanical venous thromboembolism prevention

Knowledge, risk assessment, practices, self-efficacy, attitudes, and behaviour's towards venous thromboembolism among nurses: A systematic review

AIM

This study reviewed the literature on nurses' knowledge, risk assessment practices, self-efficacy, attitudes, and behaviours towards venous thromboembolism (VTE).

DESIGN

A systematic review following PRISMA guidelines.

METHODS

CINAHL (via EBSCO), MEDLINE (via PubMed), and Web of Science were electronic databases used to find studies published from 2010 to November 2020 in English language. A Hoy critical appraisal checklist was used to assess the risk of bias and methodologic quality.

RESULTS

This study included fourteen studies conducted on 8628 Registered Nurses. Nine of the fourteen studies examined nurses' general knowledge level regarding VTE, and five showed that most nurses had a good knowledge of VTE. Of the 14 studies, six assessed nurses' risk assessment knowledge regarding VTE, and three showed that nurses had low knowledge of VTE risk assessment. Eleven studies assessed nurses' practices concerning VTE prophylaxis; 5 of the 11 studies reported that nurses had poor and unsatisfactory levels of VTE practice. Three of the 14 studies showed that nurses had low self-efficacy and varied beliefs. The most frequent recommendations were to create continuous educational programs and in-service training programs (n = 11), followed by creating institutional protocols standardizing VTE (n = 6).

CONCLUSIONS

Comprehensive educational programs and campaigns based on well-established and standardized tools should be provided to nurses to improve their VTE knowledge.

Compliance of non-pharmacological preventive practice of venous thromboembolism among Jordanian nurses

Many practices, such as non-pharmacological preventive practices, have demonstrated significant improvement and reduced the venous thromboembolism incidence. This study aims at investigating the compliance with non-pharmacological preventive practice of venous thromboembolism guidelines among Jordanian intensive care and medical and surgical nurses. Descriptive and cross-sectional with the non-participant observational design was used. This study recruited 271 registered nurses in adult medical-surgical units and intensive care units of 12 different government hospitals in Jordan's middle and north regions. The observational checklist included 10 preventive practices based on the non-pharmacological preventive of venous thromboembolism guidelines. In the observational checklist, the highest score was 20, and the lowest was 0. If the nurse received equal to or higher than (>14) score were classified as sufficient compliance, while insufficient compliance was (≤14) score. The observations period started from September 2019 until March 2020. The participants' overall mean venous thromboembolism compliance score was insufficient compliance (10.6 ± 1.6). The majority of nurses were classified as insufficient compliance 67%. "Doing foot exercise and early ambulation 2 times per day 50.3%" and "checked the integrity of the patient's skin at regular intervals 50.0%" were the highest practices done rightly and completely by half of the participants. The participants who had a bachelor of nursing degree, staff nurse, and works in the intensive care unit, are less experienced and have no previous venous thromboembolism education reported low venous thromboembolism compliance. This study presents expanded compliance regarding venous thromboembolism preventive practices among Jordanian intensive care and medical & surgical nurses, so the policymakers need to develop an initiative to improve nurses' compliance.

Improving deep vein thrombosis prophylaxis with mechanical modalities in surgical intensive care unit

Deep vein thrombosis remains a source of adverse outcomes in surgical patients. Deep vein thrombosis is preventable with prophylactic intervention. The success of noninvasive mechanical modalities for prophylaxis relies on compliance with correct application. The goals of this project were to create a guideline that reflected current evidence and expert thinking about mechanical modalities use, assess compliance with mechanical modalities, and develop strategies to disseminate an evidence-based guideline for deep vein thrombosis prophylaxis.

Assessing the appropriateness of prevention and management of venous thromboembolism in Australia: a cross-sectional study

OBJECTIVES

The prevention and management of venous thromboembolism (VTE) is often at variance with guidelines. The CareTrack Australia (CTA) study reported that appropriate care (in line with evidence-based or consensus-based guidelines) is being provided for VTE at just over half of eligible encounters. The aim of this paper is to present and discuss the detailed CTA findings for VTE as a baseline for compliance with guidelines at a population level.

SETTING

The setting was 27 hospitals in 2 states of Australia.

PARTICIPANTS

A sample of participants designed to be representative of the Australian population was recruited. Participants who had been admitted overnight during 2009 and/or 2010 were eligible. Of the 1154 CTA participants, 481(42%) were admitted overnight to hospital at least once, comprising 751 admissions. There were 279 females (58%), and the mean age was 64 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary measure was compliance with indicators of appropriate care for VTE. The indicators were extracted from Australian VTE clinical practice guidelines and ratified by experts. Participants' medical records from 2009 to 2010 were analysed for compliance with 38 VTE indicators.

RESULTS

Of the 35,145 CTA encounters, 1078 (3%) were eligible for scoring against VTE indicators. There were 2-84 eligible encounters per indicator at 27 hospitals. Overall compliance with indicators for VTE was 51%, and ranged from 34% to 64% for aggregated sets of indicators.

CONCLUSIONS

The prevention and management of VTE was appropriate for only half of the at-risk patients in our sample; this provides a baseline for tracking progress nationally. There is a need for national and, ideally, international agreement on clinical standards, indicators and tools to guide, document and monitor care for VTE, and for measures to increase their uptake, particularly where deficiencies have been identified.

Proactivity in VTE prevention: a concept analysis

Venous thromboembolism (VTE) prevention is an international patient safety issue. The author has observed gaps in prescription and provision of VTE prophylaxis, and that the attitude to VTE is often reactive rather than proactive. This concept analysis aims to explore proactivity and apply it to VTE prevention to address this. Ten databases were searched (1992-2012) using the keywords proactive, proactivity, nurse, nursing, VTE/venous thromboembolism, prevent/prevention/preventing, behaviour, DVT/PE (deep vein thrombosis, pulmonary embolism). The Walker and Avant (2010) method of concept analysis identified the defining attributes as personal initiative, taking charge and feedback-seeking behaviour. Antecedents and consequences have been identified, and empirical referents are demonstrated. Defining proactivity in VTE prevention has the potential to increase prescription and, crucially, provision of prophylaxis, thereby improving patient care, reducing avoidable harm and improving the patient experience.

Graduated compression stockings for the prevention of postoperative venous thromboembolism in obstetric patients: a best practice implementation project

AIMS

The aims of this project were twofold: to compare our current venous thromboembolism management in postoperative Caesarean section patients with the current best evidence on the use of graduated compression stockings and to standardise mechanical venous thromboembolism prophylaxis guidelines where multiple approaches had previously been used.

METHOD

Thirty post-Caesarean section patients from a private hospital in Perth, Western Australia, were audited in a three-phase project: (i) the initial audit; (ii) clinical practice change including greater venous thromboembolism awareness and targeted education for midwives, standardised guidelines for mechanical prophylaxis, the development of an online venous thromboembolism module, a venous thromboembolism prophylaxis policy and heightened consumer involvement; and (iii) a follow-up audit.

RESULTS

Our initial audit result demonstrated opportunities for improvement across all audit criteria. The interventions were undertaken over a 3-month period from August to October 2010. The follow-up audit results showed pleasing improvements across four audit criteria with one criterion unchanged.

CONCLUSION

While the follow-up audit showed significant clinical improvements, the tight time frame for the development and implementation of multiple interventions created major challenges. We believe that given time to embed these changes, further improvements will be seen. Ongoing audits will be conducted to ensure the sustainability of these changes. The change in practice and subsequent improvements demonstrated at this private hospital provide evidence to encourage other midwifery units to pursue best practice in the management of this high-risk patient cohort.

Venous Thromboembolism (VTE) Risk Assessment and Prophylaxis: A Comprehensive Systematic Review of the Facilitators and Barriers to Healthcare Worker Compliance with Clinical Practice Guidelines in the Acute Care Setting

BACKGROUND

Even though guidelines for venous thromboembolism risk assessment and prophylaxis are available, patients with identifiable risk factors admitted to acute hospitals are not receiving appropriate prophylaxis. The incidence of venous thromboembolism in hospitalized patients is higher than that of people living in the community who have similar demographics. Knowledge of barriers to healthcare professional compliance with clinical practice guidelines and facilitators to improve compliance will aid appropriate use of venous thromboembolism clinical practice guidelines.

OBJECTIVES

The main objective of this review was to identify the barriers and facilitators to healthcare professional compliance with clinical practice guidelines for venous thromboembolism assessment and prophylaxis.

INCLUSION CRITERIA

Studies were considered for inclusion regardless of the designation of the healthcare professional involved in the acute care setting.The focus of the review was compliance with venous thromboembolism clinical practice guidelines and identified facilitators and barriers to clinical use of these guidelines.Any experimental, observational studies or qualitative research studies were considered for inclusion in this review.The outcomes of interest were compliance with venous thromboembolism guidelines and identified barriers and facilitators to compliance.

SEARCH STRATEGY

A comprehensive, three-step search strategy was conducted for studies published from May 2003 to November 2011, aimed to identify both published and unpublished studies in the English language across six major databases.

METHODOLOGICAL QUALITY

Retrieved papers were assessed by two independent reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute.

DATA COLLECTION

Both quantitative and qualitative data were extracted from papers included in the review using standardized data tools from the Joanna Briggs Institute.

DATA SYNTHESIS

Quantitative data was pooled using narrative summary due to heterogeneity in the ways in which data was reported. Qualitative data was pooled using Joanna Briggs Institute software.

RESULTS

Twenty studies were included in the review with methodological quality ranging from low to high.Reported compliance at baseline ranged from 6.25% to 70.4% and compliance post intervention ranged from 36% to 100%.Eight main categories of barriers and nine main categories of facilitators were identified. The quantitative and qualitative studies identified very similar barriers and facilitators which fell under the same categories. The studies all had components of education involved in their intervention and the review found that passive dissemination or one mode of intervention was not enough to affect and sustain change in clinical practice.

CONCLUSIONS

This review identified 20 studies that assessed compliance with venous thromboembolism clinical practice guidelines, and identified barriers and facilitators to that compliance. The studies showed that many different forms of intervention can improve compliance with clinical practice guidelines. They provided evidence that interventions can be developed for the specific audience and setting they are being used for, and that not all interventions are appropriate for all areas, such as computer applications not being suitable where system capacity is lacking.Healthcare professionals need to be aware of venous thromboembolism clinical practice guidelines and improve patient outcomes by using them in the hospital setting. There are a number of interventions that can improve guideline compliance, keeping in mind the barriers and adjusting practice to avoid them.Venous thromboembolism compliance within rural Australian hospitals has not been determined, however as inequalities have been identified in other areas of healthcare between urban and rural regions this would be a logical area to research.