Ann Laramee APRN MS Martha Jo Hebert RN Linda Gruppi RN MSN

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
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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
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VTE The Most Common Preventable
In-Hospital Death
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Risk Factors for VTE
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•
•
•
Advancing age
Immobility
Obesity
Pregnancy or post
partum
• Central Venous catheter
• Estrogen based therapy
• Smoking
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•
•
•
•
Family history
Trauma
Recent surgery
Medical conditions
–
–
–
–
MI, CHF, stroke
Lung disease
Cancer
Sepsis
• Hospitalization
Prevention of VTE
• Non-Pharmacological
– Graduated
Compression
Stockings
– Intermittent Pneumatic
compression
devices(SCDs)
– Foot pumps
– IVC filters
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• Pharmacological
– Unfractionated
Heparin
– Low Molecular Weight
Heparin
– Fondaparinux
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
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FAHC Nursing Evidence-Based Practice Model
State the problem
Form a team
Evaluate
outcomes
Check research
Adopt practice
change
Synthesize Evidence
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Pilot the change
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Adopted from:
2001 Iowa Model
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Stetler’s Levels of Evidence
Level and Quality
of Evidence
Type of Evidence
Level I (strongest evidence)
Meta-analysis or systematic review of multiple controlled
studies or clinical trials
Level II
Individual experimental studies with randomization
Level III
Quasi-experimental studies such as nonrandomized controlled
single-group pre-post, cohort, time series, or matched
case-controlled studies
Level IV
Nonexperimental studies, such as comparative and
correlational descriptive research as well as qualitative
studies
Level V
Program evaluation, research utilization, quality improvement
projects, case reports
Level VI (weakest evidence)
Opinions of respected authorities; or the opinions of expert
committees, including their interpretation of non-research
based information
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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
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Next Steps
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•
•
•
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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
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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
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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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