1. Ferris State University Nursing Research Presented by: Rebecca Enright, Jiali Luc, Jenny Parish, Ashley Weststrate

2.  To analyze current literature related to the prevention of deep vein thrombosis (DVT) ◦ Review of literature on evidence based practice using heparin based products along with early ambulation ◦ Review of literature of evidence based practice with early ambulation alone

3.  DVT’s and pulmonary embolisms (PE) are the most common complications in hospitalized patients in the United States.  Between 60,000 and 100,000 patients die each year because of a DVT or PE (Van Wicklin, 2011)  Nurses play an important part in educating patients and assessment of patients knowledge (Le Sage, McGee, & Emed, 2008)

4.  The authors of this presentation reviewed a total of 11 research articles relating to the proposed question  All 11 articles were critiqued based on Ferris State University NURS 350 research article critique matrix  Of the 11 articles, four studies were chosen that had the most relevant information, appropriate methodology, and credible sources

5.  Authors Brophy, Dougherty, Garrelts, Parish, Rivey, Stumpf, Taylor & Mathis, conducted a medline data search to find and review research related to recent advances in the prevention of DVT’s (2005).  Findings of this article suggest that although specific anticoagulant regimens have been found to effectively prevent DVT’s, these prophylactic measures are underused.

6.  This article, by Le Sage, McGee, and Emed, followed a qualitative cross-sectional survey design to gather evidence about the patients’ awareness and knowledge of DVT and their perspectives on pharmacologic agents (2008).  This article address nurses’ role in patient education and advocacy

7.  The authors of the article; Pashikanti and Von Ah (2012), conduct an integrative review and synthesis of nine empirical studies  Examines what the current and best evidence shows about nursing interventions of early ambulation.  Analysis shows improvement of patient outcome pertaining to early ambulation

8.  By Sharon Van Wicklin  Discusses nine current practice recommendations related to DVT prophylaxis  Serves as a guide for nurses to help minimize patients’ risk through a multidisciplinary approach

9.  Effective prevention of DVT’s requires early assessment of at-risk people ◦ This should be completed early in hospital admission  28% of hospitalized medical patients with risk factors for venous thromboemobolism (VTE) received appropriate prophylaxis  The article by Brophy et al, clearly states that DVT prevention is best with an anticoagulant and something more non-invasive such as early ambulation if not contraindicated. (Brophy et al, 2005)

10.  One article showed that patients were satisfied with the use of anticoagulants, but less than pleased with the amount of education on prophylaxis  Patient education is imperative to helping patients adhere to prophylaxis regimes and understanding the importance in DVT prevention. (LeSage, McGee, & Emed, 2008)  Nurses are responsible for educating their patients on risk factors, signs and symptoms and prevention strategies, and compliance issues. (Van Wicklin, 2011)

11.  Another article showed evidence that anticoagulant therapy, along with early ambulation, showed improved pain rating and decreased swelling in the legs.  The study showed that facilities that implemented early ambulation had more positive outcomes (Pashikant & Von Ah, 2012)

12.  Patient barriers ◦ Vision ◦ Hearing ◦ Educational background ◦ Readiness for learning  Patients will benefit from education regarding anticoagulants and other prevention methods so it is important to define each patients barriers and address them as seen fit. (LeSage, McGee, & Emed, 2008)

13.  Based on the research, the authors feel as though it is ideal to implement a form of anticoagulant along with early ambulation if not contraindicated.  Assessments and screening tools will play an important role in deciding who is at risk for DVT’s.  With the help of a multidisciplinary team, the best suitable prevention plan can be developed for each individual patient while in the hospital on an adult medical-surgical unit.

14.  After careful review of the literature, the authors of this presentation support the idea of using anticoagulant therapy along with early ambulation to best prevent the risk of thombosis.  Research shows that nursing intervention such as early ambulation improves patient outcome  A nurse assessment is important to finding those at risk for DVT

15. Brophy, D. F., Dougherty, J. A., Garrelts, J. C., Parish, R. C., Rivey, M. P., Stumpf, J. L., … & Mathis, A. S. (2005). Venous thromboembolism prevention in acutely ill nonsurgical patients. The Annals of Pharmacotherapy, 39(7), 1318-1324. doi:10.1345/aph.1G127 Le Sage, S., McGee, M., & Emed, J. (2008). Knowledge of venous thromboembolism (VTE) prevention among hospitalized patients. Journal of Vascular Nursing, 26(4), 109-117. Pashikanti, L., & Von Ah, D. (2012). Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 26(2), 87-94. Van Wicklin, S., (2011) Implementing AORN recommended practices for prevention of deep vein thrombosis, Association of Preoperative registered nurses journal, 94(5), p 443-454. doi:10.1016/j.aorn.2011.07.018