Use Of Pharmacological Thromboprophylaxis Into Medical Surgical Patients : A Review Of Current Literature

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

Mulloy, D. F., & Hughes, R. G. (2008). Patient safety & quality: an evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.nlm.nih.gov/books/NBK2678/

Once an area of evidence-based practice has been chosen for investigation, the reviewer must locate current evidence sources and, using a structured approach, assess each for applicability to the issue being investigated. The aim of this paper is to use a Rapid Critical Appraisal Checklist (Melnyk and Fineout-Overholt, 2011) to support these sources of evidence into a review that discusses the importance of daily, high-level, multidisciplinary communication and patient safety. The summaries of these evaluations will be provided as an appraisal of each study.

Getting an infection from improper care during or after insertion of a central line is the last thing you want to get while in the hospital. This paper will discuss Kaiser Permanente’s policy on central venous catheter, also known as a central line, care and dressing change, and whether it follows the current evidence-based practice on preventing bloodstream infection in patients who have them inserted. I will explain about what a central line is, why evidence-based practice is important in the clinical setting, what Kaiser Permanente’s policy about central line care and dressing change is, if Kaiser is currently following evidence-based practice based on current articles about preventing central line associated bloodstream infections (CLABSIs), and what my role in using evidence-based practice is as a future registered nurse.

Professionalism in nursing has advanced greatly over the years. A cornerstone for change includes that of evidence based practice (EBP) as the drive of nursing intervention and patient care. According to the Quality and Safety Education for Nurses (QSEN), Evidence-based practice is described as the combination of the most recent evidence with clinical knowledge that includes the patient’s best interests in mind for greater patient outcomes (QSEN, 2017). The QSEN’s goal is to prepare nurses for improvement in quality and safety of patients (2017). Because of this goal, six competencies, including evidence-based practice, are listed for criteria of improvement in nursing practice (2017). I have been fortunate to have experience with implementing this practice and providing education in certain EBP protocols in my career. One EBP protocol in particular that our unit has been involved in since May of this year includes Enhanced Recovery After Surgery (ERAS) now referred to as Improving Surgical Care and Recovery (ISCR).

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

Multiple studies demonstrate a relationship between lower patient-to-nurse ratios and improved patient outcomes (Garrett, 2008; Penoyer, 2010; Unruh, 2008). Patient outcomes addressed in the various studies included falls, infections, length of stay, mortality, patient safety, patient satisfaction, postoperative complications, pressure ulcers, quality of care and unplanned extubation with reintubation. A 2004 report from the Agency for Healthcare Research and Quality (AHRQ) stated that adverse events can increase the cost of a total treatment by 84%, length of stay by 5.1 to 5.4 days and probability of death by 4.67% to 5.5% (Garrett, 2008).

Annie Coffey is a 72 year old woman that has developed a deep vein thrombosis (DVT) due to reduced mobility while on bed rest. This assignment will discuss the signs, symptoms, prevention and management of a DVT and the use of warfarin as long term treatment. The assignment will explain what a DVT is and discuss its potential implications. The nurse’s role in the prevention of DVTs will be discussed in detail as well as the nursing management of Annie. The importance of patient education will be highlighted throughout the assignment and important discharge advice while on warfarin will be explained.

To improve the quality, safety, efficiency, and effectiveness of patient care, applying research and evidence-based practice is necessary. In the Institute of Medicine’s report, Keeping Patient Safe: Transforming the Work Environment of Nurses, there is an emphasis on adequate nurse staffing (Hickey & Brosnan, 2012). Therefore, the quality improvement initiative is to focus on closing the gap between the core staffing and actual staffing in a six-week schedule.

All the pre-operative checks I did are important for patient safety and are derived from the World Health Organisation (WHO) surgical safety checklist (2008).The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery (WHO, 2014). The ward staff had already put on the anti –embolism stockings on the patient.

One must understand that patients who are prescribed warfarin are at a high risk of bleeding. According to Sanderson et al. (2009) “many patients were unable to link known risk factors as contributing” to DVT to their therapist (p. 25). Although patients are admitted for major lower extremity surgeries, some of these patients also have chronic diseases, such as cerebral vascular accident (CVA), coronary artery disease, diabetes, cardiac, renal disease, and obesity and might take a complex medication regimen. Therefore, these patients require a major understanding of detailed discharge education of medication regimen, side effects, and interactions to prevent them from suffering complications. Furthermore, Campbell and Selton (2010)

Thrombin is a naturally occurring protein that is present in the blood of humans and animals. The main function of thrombin is as an intermediate step during hemostasis, which slows bleeding by forming blood clots. Thrombin acts as an enzyme during an injury, converting fibrinogen to fibrin, which then causes blood clots to form. Due to its properties, thrombin’s application to the medical field includes topical surgery in the case of minor injuries as well as various other medical procedures such as neurosurgical operations. Apart from applications in the medical field, thrombin also plays significant roles by directly interacting with endothelial cells throughout the body.

The model is guided and standardized by the Perioperative Nursing Data Set (PNDS) consisting of a variation of elements such as nursing diagnosis, interventions, and outcomes (King and Sapnas, 2007) assisting nurses to utilize evidence-based practice in providing, safe, efficient patient care. The primary goal is to optimize the patient’s surgical outcome using evidence-based best practice measures in order to provide safe and effective patient care (See Appendix A).

Evidence-based practice (EBP) in nursing means making decisions about patient care on the basis of best, current, standardized practice and guidelines. According to an article, written by Dr. Kathleen Stevens, the development of evidence-based practice (EBP) is fueled by the increasing public and professional demand for accountability in safety and quality improvement in health care (Stevens, 2013). The author also mentioned in her article that the intended effect of EBP is to standardize healthcare practices to science and best evidence and to reduce illogical variation in care,

When blood is removed from a vein, it is called venipuncture or phlebotomy. Venipuncture should be performed with care. The veins of a patient are the main source of specimens for testing, the entry point of medications, and the site for IVs and blood transfusions. Because there are only a limited number of easily accessible veins in a patient, it is important that everything be done to preserve their good condition and availability. Universal precautions should be observed at all times. Gloves should always be worn when obtaining blood specimens. BEFORE BEGINNING ANY PROCEDURE—ACCURATELY IDENTIFY THE PATIENT ! Follow the proper protocol to identify the patient make positive identification of the patient by checking hospital armband for