The Development of Clinical Nursing Practice Guideline for Prevent Venous Thromboembolism (VTE) in Orthopedic Patients

Abstract

This research and development is aimed at the development of clinical nursing practice guideline for preventing Venous Thromboembolism (VTE) in orthopedic patients under the conceptual framework of Deming Cycle (PDCA) for continuous quality improvement which include 4 stages: Plan, Do, Check and Act. The 2 sample groups are 25 clinical nursing practitioners and 52 orthopedic patients. The research tools include clinical nursing practice guideline for preventing Venous Thromboembolism, survey of practitioners’ opinion on practicality of the guideline, evaluation of compliance to clinical nursing practice, nursing care key performance indicators (KPI) report, survey of nurses on their satisfaction with the use of the guideline, orthopedic patients’ satisfaction survey on nursing services. All research tools passed the test of validity consistency index and reliability assessed by using Cronbach’s Alpha Coefficient. The data analysis was conducted using percentile, mean and standard deviation and 3 groups of patients were compared by using analysis of Variation (ANOVA).

The findings of the research show: 1. The Clinical Nursing Practice Guideline for Preventing VTE in Orthopedic Patients includes VTE Risk Evaluation and Screening form of Krabi Hospital’s orthopedic patients (Modified: Autar VTE Risk Assessment Scale, 2003) and nursing care practices for preventing VTE of Krabi Hospital’s orthopedic patients by considering risk score of the patients. 2. The results of using the Clinical Nursing Practice Guideline, process results are 1) Participated nurses rated the practicality of this guideline at high. Effectiveness of the practice guideline is the most feasible ( =4.12, SD=0.60) while the least feasible is its economizing ( =3.80, SD=0.71). The nurses did not perform all the nursing practices in accordance with the risk scores. 92% gave information to the patients and their relatives on the necessity of VTE prevention and 92% encouraged early ambulation patients to have at least 2,000 cc. water/ fluids intake per day. 84% performed patient reassessment while 32% consulted attending physicians on giving the patients anticoagulant drugs which was the least performed practice. The participated nurses rated their satisfaction with the guideline at highest ( =4.63, SD=0.57). 2) All 52 orthopedic patients were evaluated and screened for risk of VTE. They were separated into 3 groups: 5.77% were low risk, 42.31% were medium risk and 38.46% were high risk. The satisfaction with the overall nursing care services was rated high by low-risk group ( =4.00, SD=1.00), by medium-risk group ( =3.86, SD=0.64) and also by high-risk group ( =3.93, SD=0.47). The incidents of VTE were found in 5 orthopedic patients in high-risk group equaling to 9.6% of the participated patients, however, none were found in those in low- or medium-risk groups. There was no incident of death from VTE in every group of patients.

            In conclusion, the Clinical Nursing Practice Guideline for Preventing VTE in Orthopedic Patients can be used as nursing practice guideline throughout the organization resulting in how patients receive standard nursing care and know treatment process and in reducing, preventing or giving proper nursing care in case of any complication. These all lead to patients’ safety and satisfaction with nursing service.