Running head: NURSING ACCOUNTABILITY Nursing Accountability Sarah Redmond Grand Canyon University Professional Dynamics NRS-430V July 24, 2011 Nursing Accountability Venous thromboembolism (VTE) is a disease that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). More than 2 million Americans suffer from VTE each year, with over half of these individuals developing their VTE in the hospital or in the 30 days post hospitalization. In a large registry trial capturing more than 5,450 patients at 183 sites over a 6-month period, 50 percent (2,726) developed their VTE during hospitalization.
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Nurses are accountable in helping change the practice of venous thromboembolism prophylaxis. There are many risk factors that can cause VTE including recent hospitalization, surgery, prolonged immobility, recent travel, trauma, and certain conditions including heart disease, respiratory disease, cancer, and clotting disorders. In our study, waist circumference was more predictive of a VTE than body mass index. We also found that heavy smoking predicted a VTE, whereas hypertension did not (Hansson et al. , 1999). There are pharmacological and non pharmacological ways to protect patients in the hospital setting.
Using these in conjunction with each other is the overall safest method. Non pharmacological methods of VTE prophylaxis include early ambulation, sequential compression devices (SCD), and compression stockings. Early ambulation promotes venous return and helps minimize length of stay in hospitals. Compression stockings and SCDs help prevent venous stasis. A recent systematic review found that graduated compression stockings, intermittent pneumatic compression devices, and foot pumps reduce the risk of DVT in surgical patients by two thirds when used in monotherapy and by an additional 50% when added to drug prophylaxis (Roderick et al. 2005). Pharmacological methods of VTE prophylaxis include anticoagulants such as low molecular weight heparin, unfractionated heparin, and vitamin k antagonists. These medications are given to prevent clot formation, not to actually dissolve the clots. It’s important to know which patients are at greater risk and which type of prophylaxis should be used. In most hospitals there is a VTE protocol that is followed to determine the risk level of patients and which prophylactic measure to implement.
It’s important for medical personnel to help develop and implement these VTE protocols. These protocols should be mandated in every hospital at time of admission. Doctors need to review VTE risks for patients and order which prophylactic measure to use along with admission orders. In addition to the doctor’s risk assessment for VTE, nurses should assess their patients for risk factors and signs or symptoms. If prophylactic measures are not ordered, nurses can ask the doctor if they feel prophylaxis is warranted or make them aware.
Quality improvement teams can be initiated throughout hospitals. Team members can help develop, improve, and review VTE protocols to make sure they are being ordered and are effective in prevention. There are many ways nurses can be accountable in the prevention of venous thromboemobolisms. Nurses can walk high risk patients often and help patients perform leg exercises without a physician’s order if not contraindicated. Proper measurement and correct application of compression stockings are essential to their performance, so helping the patients with this would be beneficial.
There should be frequent assessments of patient’s skin integrity, pulses, and comfort when using compression stockings. Patient education is very important in the prevention of VTE. Nurses should make sure patients understand reasons for the different prophylactic measures and make them aware of signs and symptoms to watch for. Proper medication administration of anticoagulation agents is essential, as with any other medication. It’s important to have the patient’s exact weight, because even the slightest wrong dose of some of these anticoagulants can be very detrimental and even kill a patient.
To make sure these medications have a purposeful effect, it is important to teach the patients how to take them properly. Nearly two-thirds of 9,675 medical patients at risk for venous thromboembolism received no inpatient pharmacologic prophylaxis, and more than 98% received no outpatient prophylaxis, a retrospective analysis showed (Wendling, 2010). Prophylaxis is the most important way to prevent these deadly venous thromboembolisms from forming. References Agency for Healthcare Research and Quality. (2011). Retrieved from Healtheappointments.com
Hansson, P. O. , Eriksson, H. , Welin, L. , Svardsudd, K. , Wilhelmsen, L. (1999). Smoking and abdominal obesity. Archives of Internal Medicine, 159(16), 1886-1890. Roderick, P. , Ferris, G. , Wilson, K. , Halls, H. , Jackson, D. , & Collins, R. et al. (2005). Evidence based guidelines for the prevention of venous thromboembolism. Health Technology Assessment, 9 Wendling, P. (2010). Many at-risk patients lack VTE prophylaxis. American College of Chest Physicians. Retrieved from http://www. chestnet. org/accp/article/chest-physician/many-risk-patients-lack-vte-prophylaxis