Evidence Based Practice Regina Cadenhead Jefferson College Evidence Based Practice Venous thromboembolism refers to the formation of a blood clot in a blood vessel. While clots can form in an artery or a vein, this article focuses only on clots that occur in a vein ("," 2015). Critically ill patients are at an increased risk of a venous thromboembolism (VTE) due to VTE can manifest as a deep venous thrombosis (DVT) or a pulmonary embolism (PE). Risk factors include venous stasis, vascular injury, and hypercoagulable disorders. A majority of ICU patients carry at least one risk factor for VTE; additional risk factors are considered to have a cumulative effect…it is impossible to predict which patients will experience a …show more content…
Unfortunately, “VTE comprised of DVT and/or PE represent a serious public health challenge, affecting up to 600,000 Americans annually. The consequences can be deadly; VTE has been identified as the most common cause of preventable mortality in hospitalized patients, accounting for up to 10% of hospital deaths” (Shermock et al., 2013, p. 1) It is imperative that all patients admitted to the ICU should be assessed for VTE. The assessment should be done frequently. It is important to assess both subjective and objective data. Past medical history is very important. It is essential to find out if the patient has any predisposition to a VTE including any trauma to veins, any varicosities, obesity, COPD, HF. Certain medications can also put a patient at risk for VTE such as oral contraceptives, hormone therapy, tamoxifen, or raloxifene. Also, any recent surgeries such as orthopedic, gynecologic, gastric, or urologic and past surgeries involving veins or a central venous catheter can put a patient at risk. Objective data includes fear, anxiety, and pain. Monitor vital signs frequently. Check the integumentary system for symmetry; taut, shiny, warm skin, erythematous, tender to palpation. Not every patient
Central venous catheters (CVC) have become the most efficient means to administer long-term, vital medical treatments in hospitalized patients. These catheters are used in almost all types of medical settings for purposes related to, “hemodynamics monitoring, parenteral nutrition, chemotherapy, hemodialysis etc.” (Gorji, Rezaei, Jafari, Cherati, 2015, p.1). Its clinical relevance has become extremely significant in relation to treating patients with all sorts of medical diseases who necessitate the administration of extravasation drugs that can solely be administrated by a CVC. Therefore, CVC have “led to reduction in duration of hospitalization, increment of safety and reduction of hospital charges” (Gorji et al., 2015, p.1). Its benefits
Additionally, as you already might learn from your experience, DVT is a blood clot that develops in deep veins, usually in the lower leg. It could be dangerous because the clot may become large, or it could break in
The incorporation of evidenced-based practice (EBP) into nursing practice is supported by research to positively improve the quality of care and improve patient outcomes. EBP is important to the nursing profession because it also leads to increased job satisfaction, teamwork, and levels of engagement in clinicians (Melnyk, et al., 2017). Miniature research projects such as quality improvement projects, surveys, and clinical research studies are frameworks used to get feedback and data from patients during their time spent in health care systems. EBP is not the standard of care in many health care systems (Melnyk, et al., 2017). This due to many factors, including lack of EBP mentors, nursing programs that do not incorporate EBP into the curriculum,
Emergency department (ED) nurses save lives every day by utilizing their skills and knowledge to assist the physician in providing emergent care to patients who arrive via ambulance or by private auto. Nurses are aware of their responsibilities to respond to the patient's needs quickly and efficiently to provide life-saving interventions and care. However, are ED nurses aware that they contribute directly and indirectly to a large percentage of patient's demise through the insertion of foley catheters, peripheral
In this essay, I am going to consider how evidence-based practice can be used to support, justify, legitimate and/or improve clinical practice. I am also going to explore and discuss primary and secondary research evidences about how nursing interventions can potentially improve the quality of life of patients in the community suffering from heart failure. I will gather these evidences using a literature search which I will include an account of. Using a critiquing framework for support, I will appraise both primary and secondary evidences that I have chosen. I will also look at potential non-evidential factors that can influence evidence utilisation in practice. Finally, a conclusion will be drawn.
Evidence based practice is the incorporation of individual clinical expertise with best research evidence and patient values and expectations. Health care decision of individual patients should be based on best available research evidence. A health decision made from a sound research evidence has the potential to ensure best practice and reduce variations in health care delivery. In health science, an ever increasing plethora of studies being published and is challenging for clinicians to keep up with the literature. Integrating research into practice is time consuming and need methods for easy access to such evidences for busy clinicians. Indeed, clinical decision should be based on the latest research evidence. Systematic reviews and meta-analyses summarize the research evidence, which is generally the best form of evidence, thereby making the available evidence more accessible to decision makers and are positioned
It is difficult to draw any conclusions regarding risk factors of inadvertent arterial catheterizations due to the lack of a control group. However, four of eleven (36 %) inadvertent arterial catheterizations were made urgently in patients with major trauma in Study III, whereas only 5 % of venous cannulations in Study IV were carried out in emergent situations, indicating that this truly is a risk factor. As indicated by our results, a diagnosis of inadvertent arterial catheterization is often obvious immediately or during initial clinical use due to local symptoms of bleeding or abnormal back-flow of blood through the catheter. Other clinical bedside signs facilitating this diagnosis – in normovolemic patients without central hypoxaemia – include the spout, at systemic pressure, of bright red and/or well oxygenated (confirmed on blood gas analysis) blood by the catheter (Shah 2004).
A patient is indicated for closure if they experience symptoms, irrespective of age, to reduce subsequent morbidity and mortality (21). To reduce this risk, closure should be considered in patients at risk of a paradoxical embolism, such as patients undergoing pacemaker implantation or professional divers (5,
In healthcare, evidence based practice (EBP) has grown and become important in providing the best quality care possible to patients. There are numerous ways to collect and use the research in the nursing profession. Studies are constantly being done to help better nursing and all of the healthcare field in order to help patients live better and maintain their health. There are different types of research such as qualitative and quantitative. Qualitative uses the human experience or something that has been lived by someone and quantitative examines for meaning and goes more in depth to research things and strives to test a hypothesis or makes use of statistical data to answer research questions (LoBiondo-Wood
Thrombus formation starts in the calf and extends proximally. They mostly begin intraoperatively, but can also start a few days to a month. A thrombus is composed of fibrin and red cells. The development of thrombosis can result from endothelial injury, abnormal blood flow, and/or hypercoagulability. High risks include obesity, prolonged immobility, cancer, smoking, estrogen use, advancing age, varicose veins, dehydration, splenectomy, and orthopedic procedures.
Choosing a vein for an I.V. is challenging. Berman and Snyder (2016) mention that while caring for a patient that has to have
Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).
Venous thromboembolism (VTE) has become a major health concern with 300,000-600,000 of cases in the United States annually and contributes to a significant number of avoidable inpatient costs (C. Dooley, 2013). Venous thromboembolism is also cited as the leading cause of preventable in-patient deaths (Dooley, 2013). Research has indicated that post-operative patients on medical surgical units have a 13-31% risk of deep vein thrombosis without interventions using prophylactic antithrombotic therapy (Alhazzani et al., 2013). Deep vein thrombosis (DVT) is a common, yet preventable postoperative
Pulmonary embolism, synonymous with deep vein thrombosis; are important and is a growing public health problem. Both contribute to the 300,000-600,000 individuals affected by this each year in the US alone. This condition does not discriminate against age, gender, or race and occurs across all boards causing morbidity and mortality. When misdiagnosed, unrecognized, or untreated, PE can cause death quickly; within just an hour. It’s fatal in up to 26% of cases (Andrews, 2010). However, prompt treatment greatly reduces the risk of death. Taking the necessary preventative measures to prevent blood clots is the key to protecting one’s self of these conditions.
This study suggested that providing VTE prophylaxis training to nurses would prevent VTE from occurring. To prevent VTE and other vascular disorders the nurses should get appropriate training. Furthermore, nurses must encourage their patients to use anticoagulant such as low-dose unfractionated heparin (LDUH), low molecular weight heparin (LMWH), Fondaparinux, Rivaroxaban and Dabigatran and mechanical devices such as Compression Stockings and Intermittent and pneumatic Compression (IPC) consecutively that decrease the development of VTE 51-80%. The research also encourages nurses and other health care professional to educate patients and their family member to prevent VTE from occurring that include early ambulation post-surgery and proper