Improving compliance to venous thromboembolism prophylaxis in total knee and hip replacement patients using multiple strategies

34^th International Nurse Education & Nurse Specialist Conference

November 08-09, 2017 | New Orleans, USA

Panjwani N, Khan K and Verasiya S

Aga Khan University Hospital, Pakistan

Scientific Tracks Abstracts: Adv Practice Nurs

Abstract :

Objective: In Orthopedic Surgeries like Total Knee and Hip Replacements, Deep Vein Thrombosis (DVT) increases the Morbidity and Mortality of patients. Venous thromboembolism (VTE) Prophylaxis is beneficial in reducing and preventing DVT. However, compliance to VTE prophylaxis is a major concern in many healthcare settings. The objective of this quality improvement project was to improve the compliance to VTE prophylaxis and decrease incidences of VTE in Total Knee and Hip replacement patients. There were two cases of pulmonary embolism reported in post knee replacement and one case in post hip replacement surgeries over a period of 13 months (August 2015- August 2016) and in all these patients there was an omission of VTE prophylaxis. Methods: The project was conducted at The Aga Khan University Hospital from September - December 2016. It was a pure nursing initiative where a team of nurses was involved to ensure compliance to VTE prophylaxis. The strategies employed for quality improvement were to enhance the awareness of physicians to the protocol of VTE prophylaxis, reinforcement of the same to the residents and interns, and daily checks to monitor the compliance to VTE prophylaxis of all patients who underwent Total Knee and Hip Replacement Surgeries. In addition to that in the daily rounds head nurses, nurse instructor and the clinical nurse coordinator would check for compliance to this protocol on their daily rounds. During the weekend, the nurse team leader on coverage would check for the compliance to this prophylaxis. Feedback was provided to the medical team taking care of the patient if any omission or deviation from the protocol occurred. Reinforcements were done for the physicians in their weekly meetings and reminders were sent to those who omitted the inclusion of prophylaxis in their physician orders through whatsapp messages or face to face communication. Results: In this study total number of patients, who underwent total hip or knee replacements, met the criteria for VTE prophylaxis was 47. All these patients were monitored for compliance to VTE prophylaxis. Of these 47, there were about 7 (15%) patients who did not receive the prophylaxis post operatively. After communicating with the residents the order for the prophylaxis was entered. The compliance rate soon after the implementation was 100% and there was no single mortality or morbidity due to DVT. Conclusion: In this quality improvement project, the use of multiple strategies increased the compliance to VTE Prophylaxis.

Biography :

Panjwani N currently heads the Musculoskeletal and sports medicine service line as a Nurse Manager at the Aga Khan University Hospital, Karachi. Prior to this she was the Nurse Administrator for Surgical Units at the same institution. She possesses a vast experience of 15 years in the field of Health Care and Education. Cosmic experience has gained over the period of years from Senior Instructor at Aga Khan University School of Nursing and Midwifery to clinical practices in critical care areas such as the emergency room and post anaesthesia recovery room, and other areas such as day care surgery, endoscopy and lithotripsy departments of a tertiary care hospital. She has completed her masters in Nursing in 2014 from the Aga Khan University School of Nursing. She has published two articles and has presented twice at international conferences.