colleagues helping achieve model practice evidence based practice committee modeling evidence based...
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ColleaguesHelpingAchieveModelPractice
EVIDENCE BASED PRACTICE COMMITTEE MODELING EVIDENCE BASED PRACTICE:
SEQUENTIAL COMPRESSION DEVICES
Ann Laramee APRN MS Martha Jo Hebert RN
Hollie Shaner-McRae DNP RN FAANLinda 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• Advancing age• Immobility• Obesity• Pregnancy or post
partum• Central Venous catheter• Estrogen based therapy• Smoking
• Family history• Trauma• Recent surgery• Medical conditions
– MI, CHF, stroke– Lung disease– Cancer– Sepsis
• Hospitalization
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Prevention of VTE
• Non-Pharmacological– Graduated
Compression Stockings
– Intermittent Pneumatic compression devices(SCDs)
– Foot pumps– IVC filters
• Pharmacological– Unfractionated
Heparin– Low Molecular Weight
Heparin– Fondaparinux
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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
Evaluate outcomes
. Pilot the change
Adopt practice change
State the problem Form a team
Synthesize Evidence
Check research
FAHC Nursing Evidence-Based Practice Model
Adopted from:2001 Iowa Model
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Stetler’s Levels of Evidence
Level and Qualityof 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
• 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