TESTING A TOOL(FORM) FOR HOSPITALIZED PATIENTS TO PREVENT DVT - Essay Example

Introduction Background: Complications that arise in patients that require hospitalization is an area of serious concern in hospital settings. Venous thromboembolism (VTE) is among the more common complications that are seen in patients hospitalized for various surgical procedures or acute medical illness. Cohen, et al , 2008, point out that between five to ten percent of mortality in hospitalized patients is due to VTE, making it the one of the most common causes of in-hospital deaths, and yet it is preventable.

In addition VTE is responsible for increased patient morbidity and enhanced costs of hospitalization (Cohen, et al , 2008). Deep vein thrombosis (DVT) and pulmonary embolism (PE) are the main components of VTE. According to Kahn, et al, 2007, such symptomatic events are seen in medical patients that make up sixty percent of all hospital admissions. These thromboembolic events are preventable and the American College of Chest Physicians (ACCP) constantly provides guidelines on the basis of updated evidence on the prevention of VTE (Kahn, et al, 2007).

The latest guidelines from ACCP recommend the use of thromboprophylaxis options in the prevention of VTE among patients with moderate to high risk for VTE. There is strong scientific evidence supported by solid principles in the use of thromboprohylaxis as recommended by ACCP. Many of the hospitalized patients have one or more risk factors for VTE, which are usually cumulative. In the absence of any prophylaxis, objective evidence suggests that between ten to forty percent of patients admitted for medical illnesses or general surgery and forty to sixty percent of those patients admitted for orthopedic surgery develop VTE.

This gives strength to the relevance of thromboprophylaxis in hospitalized patients (Geerts, et al, 2004). However, Arnold, Kahn, and Shrier, 2001, claim that in spite of ACCP guidelines encouraging the use of thromboprophylaxis in the prevention of VTE, these guidelines are not always followed leading to the occurrence of VTE. Furthermore the inadequacy seen in the use of prophylaxis stems quite often from omission of prophylaxis (Arnold, Kahn & Shrier, 2001). Problem Statement: The ACCP guidelines recommend the use of prophylaxis in the prevention of VTE, to reduce the mortality and morbidity of patients hospitalized for surgical procedures and medical illness.

Yet, there is inadequacy in the use of prophylaxis in the prevention of VTE, which frequently is due to omission on the part of the physicians. Purpose of the Study: The purpose of this study is to evaluate the effectiveness of an intervention designed to implement an evidence based program to improve venous thromboembolism (VTE) prophylaxis among hospitalized patients.Rationale and Theoretical Base for Investigation: The risk period for the development of VTE is relatively well understood and there is a high incidence of VTE as a complication in hospital and immobilization.

Thromboprophylaxis is a known preventive measure for VTE. The ACCP guidelines recommend the use of prophylaxis in preventing VTE for patients with moderate to high risk for the development of VTE. Sjalander, et al, 2007, point out that VTE prophylaxis is not used as extensively as it should, particularly in the case of acutely ill medical patients in spite of the consensus on its use in the prevention of VTE. Research Questions:1. In hospitalized patients, what is the effect of the intervention on the proper use of either lovenox sub-Q, heparin sub-Q, ted hoses, sequential compression devices, or any combination of these?2. In hospitalized patients, does the effect of the intervention on the proper use of either lovenox sub-Q, heparin sub-Q, ted hoses, sequential compression devices, or any combination of these, vary according to patient specific factors?

Literary ReferencesArnold, M. D., Kahn, R. S. & Shrier, I. (2001). Missed Opportunities for Prevention of Venous Thromboembolism. Chest, 120, 1964-1971.Cohen, T. A., Tapson, F. V., Bergmann, J., Goldhaber, Z. S., Kakkar, K. A., Deslandes, B., Zayaruzny, M. W., Emery, L. & Anderson, A. F. (2008). Venous thromboembolism risk and prohylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet, 371, 387-394.Geerts, H. W., Pineo, F. G. Heit, A. J., Bergqvist, D.

, Larsen, R.M., Colwell, W. C. & Ray, G. J. (2004). Prevention of Venous Thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 126, 338S-400S. Kahn, R. S., Panju, A., Geerts, W., Pineo, F. G., Desjardins, L., Turpie, G. G. A., Glezer, S., Thabane, L. & Sebaldt, J. R. (2007). Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thrombosis Research, 119, 145-155. Sjalander, A., Jansson, H. J., Bergqvist, D.

, Eriksson, H., Carlberg, B. & Svensson, P. Efficacy and safety of anticoagulant prophylaxis to prevent venous thromboembolism in acutely ill medical inpatients: a meta-analysis. Journal of Internal Medicine, 263, 52-60.