Authors (including presenting author) :
So HM(1,2), Ng ML(1,3), Pun WC(1,4), Lee CH(1,2), Yip ML(1,5), Wong PH(1,6), Yip MY(1,7), Lui KH(1,3), Yee WS(8), Leung PNC(9), Lam KWE(10), Ling WM(1,11), Hui TPB(8)
Affiliation :
(1) Working Group on Evidence-based Practice, Nursing Services Division, PYNEH (2) Department of Intensive Care, PYNEH (3) Department of Neurosurgery, PYNEH (4) Department of Anaesthesia, PYNEH (5) Department of Surgery, PYNEH (6) Department of Orthopaedics & Traumatology, PYNEH (7) Department of Obstetrics & Gynaecology, PYNEH (8) Nursing Services Division, PYNEH (9) Quality & Safety Office, HKEC (10) Department of Physiotherapy, PYNEH (11) Department of Clinical Oncology, PYNEH
Introduction :
Venous thromboembolism (VTE) may present as Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE), which is clot formation in patient’s lower limbs or pulmonary arteries respectively. The impact of VTE is medically serious and even fatal in PE. Therefore non-pharmacological measures for VTE prevention are highly recommended especially in those patients at risk of bleeding with anticoagulant prophylaxis. Although mechanical devices for VTE prevention have been widely used in PYNEH, various practices were noted. Therefore an EBP project was initiated, aiming to standardize the nursing practice among different specialities for VTE prevention.
Objectives :
1. Synthesise the evidence on non-pharmacological measures for VTE prevention into a guideline for surgical patients across different departments. 2. promote the implementation of the guideline
Methodology :
An EBP Working Group was established. Johns Hopkins Nursing PET model (practice question-evidence-translation) was adopted. Literature appraisal was conducted. Evidence and recommendations were incorporated to develop a guideline on non-pharmacological measures to prevent VTE. Then measures for promotion and facilitation of easy application of the guideline among departments were designed such as preparation of a quick guide, a standardised nursing care plan and nursing prescription. Before the full implementation of the practice, a pilot was launched in Department of Anaesthesia, ICU, O&G, O&T, Neurosurgical and Surgical units. Finally a noon forum was organized in collaboration with Department of Physiotherapy for promotion of evidence and dissemination of the EBP guideline.
Result & Outcome :
The evidence showed Graduated Compression Stockings (GCS) or Intermittent Pneumatic Compression (IPC) could significantly reduce the number of VTE. In addition, thigh-length GCS did not show statistical benefit over the knee-length GCS. Promotion of early ambulation, adequate hydration, education to frontline nurses and team approach were essential elements for effective VTE prevention. Based on the evidence and recommendations, an EBP guideline on “Management of patient with the use of non-pharmacological measures to prevent VTE” was prepared. The GCS or IPC sleeves were single patient used and transferable from ICU to general wards to facilitate the continuity of care. Furthermore, 23 patients were recruited to trial use the standardised nursing practice for VTE prevention, which was well accepted by nurses. A user-friendly tailor-made tape prepared by Department of Physiotherapy was also introduced at the forum for quick calf measurement and selection of an appropriate size of GCS. Lastly, 114 participants (105 nurses and 9 physiotherapists) joined the forum and most of them (>90%) gave positive responses. Conclusions: The project was successfully implemented in October 2018, which significantly helped to build up collaboration among health care providers on VTE alertness and preventive measures. Finally, the quality of patient care could be improved and maintained.
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