Elizabeth Mitchell RN



Deep Vein Thrombosis ProphylaxisElizabeth A. MitchellFerris State UniversityAnnotated BibliographyCamporese, G., Bernardi, E., Prandoni, P., Noventa, F., Veriato, F., Simioni, P., Ntita, K., Salmistraro, G., Frangos, C., Rossi, F., Cordova, R., Franz, F., Zucchetta, P., & Kontothanassis, D. (2008). Low-molecular weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: A randomized trial. Annals of Internal Medicine 149(2): 73-82.This article was authored by a group of medical professionals working on an Angiology Unit at the University Hospital of Padua in Italy. It is published in a peer reviewed biomedical journal, targeting the medical community. In this study, low molecular weight heparin (LMWH) was compared with compression stockings for prophylaxis of deep vein thrombosis (DVT) in patients just having undergone knee surgery. It was a randomized, controlled, blind research study with 1761 patients. These patients were randomly assigned either compression stockings or once a day LMWH for seven or fourteen days. The study concluded that LMWH reduced proximal DVT more than the compression stockings. This study was a research study comparing the two prophylaxis treatments this nurse is researching. Although it was focused on DVT prophylaxis after surgery, this nurse can still apply results to the hospitalized setting of her patients.Caprini, J.A. (2010). Mechanical methods for thrombosis prophylaxis. Clinical and Applied Thrombosis/Hemostasis. 16(6): 668-673. doi: 10.1177/1076029609348654This article was authored by Joseph A. Caprini, who is a well published author in many medical journals. He is the Clinical Professor of Surgery at the University of Chicago’s Pritzker School of Medicine. His career focus is on vascular surgeries, diseases and complications. His credentials and expertise in this area are extensive. This specific article focuses on the different methods of preventing DVTs. He researched the most highly used methods and compared studies to accurately provide information on each device. He concluded that DVT prophylaxis is needed after surgeries. Each patient must be looked at as to whether he/she will be compliant with therapy or if he/she has a high risk of bleeding when determining which prophylaxis to use. He also concluded that using a pharmacological method along with compression garments had the best outcomes in patients. The article targets medical professionals and is easy to read with significant information. It was a great asset to this nurse’s research.Qaseem, A., Chou, R., Humphrey, L.L., Starkey, M., & Shekelle, P. (2011). Venous thromboembolism prophylaxis in hospitalized patients: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 155: 625-632.This article was written to set recommendations by the American College of Physicians. The authors are medical professionals with backgrounds in research and are a part of the Clinical Guidelines Committee of the American College of Physicians. This article is a review of the current research in thromboembolism prophylaxis. The recommendations that came with the article were to assess the risk of thromboembolism and bleeding in patients before beginning a treatment, use pharmacologic interventions unless contraindicated and not to use compression devices to prevent DVTs. This study is targeting the medical community and was an easy read/review. It was an interesting read to relate to this nurse’s research, giving a differing opinion on some of the options. It was valuable because so many research studies were analyzed to make this article.Elements of ReasoningElement of Reasoning1-3 sentences describing your thoughts on the issue related to that elementPurpose (all reasoning has a purpose)Deep vein thrombosis (DVT) leading to thromboembolism is a major problem seen in hospitalized patients, especially those with cardiac problems or history. The purpose is to find out the best practices to prevent DVT’s in hospitalized cardiac patients.Questions at issue or central problem (all reasoning is an attempt to figure something out, to settle some question, solve some problem)Is it better to use compression devices or pharmacologic interventions to prevent DVT’s? Should every patient admitted to the hospital cardiac floor have DVT prophylaxis? Point of view (all reasoning is done from some point of view; think about the stakeholders)The patient and hospital will both benefit from an evidence based regimen to prevent DVT’s during and after a hospital stay. It will also prevent terrible complications in the patient including pulmonary embolism which take many lives each year. Developing a DVT while in the hospital will cost the hospital and patient more money with a longer stay and more interventions. Information (all information is based on data, information, evidence, experience, research)Patients on my cardiac unit almost always receive some sort of DVT prophylaxis. I have noticed more sequential compression devices (SCDs) instead of low molecular weight heparin (LMWH). The research seems to favor low molecular weight heparin (Camporese et.al. 2008). There is also evidence that when used together, SCDs and LMWH prevent even more DVTs and pulmonary embolisms (Caprini, 2010). Finally, a study by the American College of Physicians recommends the use of LMWH but does not recommend the use of SCDs (Qaseem, Chou, Humphrey, Starkey & Shekelle, 2011).Concepts and ideas (all reasoning is expressed through, and shaped by, concepts and ideas)DVTs are seen more often in cardiac and hospitalized patients, so it is agreed upon that prophylaxis of these patients needs to be put into place. Since every patient situation is different, it is important to assess risk factors, like risk for bleeding, before deciding on a prophylaxis method. Also, patients that move around often, even if in the hospital may need no prophylaxis at all. Compliance can also be an issue with SCDs. It is important to look at every aspect of the patient and his/her health before deciding on a medical prophylaxis treatment.Assumptions (all reasoning is based on assumptions-beliefs we take for granted)We assume that all hospitalized cardiac patients are at risk for DVTs. Many people assume the way they have been preventing DVTs is effective, even if it has not been. We also assume one of these treatments will work if implemented and that the doctor will always prescribe the right treatment.Implications and consequences (all reasoning leads somewhere. It has implications and when acted upon, has consequences)Not providing DVT prophylaxis can lead to thromboemobolitic events like pulmonary embolism or stroke. This can lead to complications and even death. Some major consequences of treatment are the risk of bleeding from using LMWH or risk of irritated skin or dislodging current blood clots from using SCDs.Inference and interpretation (all reasoning contains inferences from which we draw conclusions and give meaning to data and situations)It is important to be aware of the risk hospitalized cardiac patients are for developing a DVT. Choosing the correct method for your patient depending on the individual’s situation and needs can prevent thromboemobolitic episodes and consequences.Personal ReflectionHow did the planning process, where you thought about what you wanted to change, prepare you for the EBPP? In thinking about what I wanted to change, I thought through many of the elements of reasoning. When I began the project I already had a purpose, knew what was practiced at my work, had assumptions and understood the major concepts. There are always many things at work I wonder about and do not have the time to change or research. In narrowing this down, I decided to go with what I thought was the most relevant and important to my job on a daily basis. Adding the research to back up my planning and thinking was very rewarding.How did the peer evaluation process prepare you for the EBPP? The peer evaluation process helped me to reevaluate what I had already done. I think the part that helped me the most in understanding the elements of reasoning was reading other proposals and critiquing them. This was much harder for me than doing my proposal on my own; it made me think differently by trying to understand the author’s purpose and thinking. I did get some good feedback from the two people critiquing my research, but I decided not to add much because I wanted to keep it concise and to the point.Do you feel you are prepared to elicit change in your practice with your proposal? How does it fit into quality health care? I think my proposal was very interesting. The doctor is the individual prescribing these treatments, so just giving him/her information and my opinion will be something I do in the future. I found out that there is no best treatment for each individual person. In other words, the best treatment for one patient may not be the best treatment for another. I will continue to give LMWH or Lovenox and work hard on encouraging compliance with compression devices. The research was mixed with what works and does not, this is why I believe it is mostly an individualized care that needs to be implemented. The one thing that every article I read agreed upon was the need for DVT prophylaxis. This helps validate what we are already putting into place at the hospital.What could you have done better? I had a really hard time finding research on specifically cardiac inpatients at the hospital. All of the research I found looked into individuals after surgery. I wish I would have had more time and taken more time to find specifics on cardiac patients. This will come in time as I continue to improve my research abilities. Next time, I would also like to choose something that I have more authority over. As I said earlier, I was looking into something that a doctor makes a decision on and I follow through. It will help me to be a better advocate for my patients though.How well do you think you are using the EOR? Do they make sense to you (why or why not?) The elements of reasoning make complete sense to me. There are many I was already using when thinking critically. A few I did not think about were the assumptions and point of view. It took me a little bit of time to understand these two areas, but eventually I really grasped the concepts and now also understand their importance. I think I am using them well after myself and my peers evaluated my work. I will continue to use these elements of reasoning in my critical thinking in the future. ................
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