Post-op Risk and Management of Deep Vein Thrombosis - Term Paper Example

Abstract According to Carter & Dunston (2007), Deep Vein Thrombosis is a condition that can be fatal if not checked in advance (p.39). (Royal Australian College of General Practitioners 2006, p.72) .This report provides an outline of current issue that impact on patient outcomes within the operation theatre while on placement. The report covers practises that are in use in prevention and treatment of Deep Vein Thrombosis as well as the best approaches in handling the same. It further provides an outline of the current strategies, policies and procedures that are in se in the Queensland Health department on DVT. The report goes ahead to draw an analysis of the cost of DVT to the healthcare system in Queensland. The report also provides an introduction into DVT which precedes the aim of the report. In addition, it draws a summary of the inclusion of the study in reference to the study topic. The inclusion covers the current issues on patient outcome in the operation theatre. Consequently, it captures an analysis of data collection methods and its analysis, and concludes with recommendations in the best way to handle the DVT condition. Table of contents 1.0 1.0 Introduction 2 1.1 Aim. 3 1.2 scopes 3 1.3 Background. 3 2.0. Data collection methods. 8 3.0 Analysis of data. 9 4.0 Conclusions 9 4.1 Recommendations 10 5.0 Reference list 10 1.0 Introduction Deep Vein Thrombosis is a life threatening condition which occurs when a thrombosis develops in a vein (Carter & Dunston 2007, p.39). It is the most common type of venous thromboembolism that occurs in the veins of legs and pelvis (Royal Australian College of General Practitioners 2006, p.72). The risk of DVT is accelerated by major surgeries (such as hip or knee replacement), cancer, and hospitalization for major hospital illness (Qadan et al 2008, p.654). PE (pulmonary embolism) is a life threatening complication DVT which occurs when the part of a clot is detached from the wall of the blood vessel. The clot is transported in the direction of the blood flow resulting into pulmonary embolism. 1.1 Aim. This report aims at developing a review of the current issues impacting on patient outcomes within the operating theatre while on placement. It provides a justification on recommendations that are needed in order to improve patient outcomes. 1.2 scopes The report provides an outline of the current issues that have an impact on patient outcomes inside the operation theatre while on placement. It provides a review of the current practises for prevention / treatment of DVT pre and post-op such as antithrombolitic stockings and prophylactic use of subcutaneous cleaned or heparin injections. The report also outlines the best practise recommendations, strategies that are there in place within the Queensland Health for the reduction of risk posed by DVT, and the polices and procedures that are there in the QLD Health. The report also provides an analysis of the cost to the health system in Queensland. 1.3 Background. Patient Outcomes should be a priority in the nursing care that nurses deliver to patients. During a nurse’s every day practice they have a responsibility to identify risk factors and implement strategies to prevent adverse outcomes from occurring to patients. Each clinical setting has its unique issues that may be more prevalent than in other areas (Mylne 2008, p.81). Deep Vein Thrombosis (DVT) and pulmonary embolism (PE) are two aspects of one disease process commonly known as venous thromboembolism (VTE) (NMHRC 1999, p. 11). However, these two aspects differ in the manner in which they occur. In DVT, a blood clot forms in the deep veins of either the leg or the pelvis which may result into pain, swelling or tenderness of the leg (Warwick et al 2007, p.803). On the other hand, part or the entire clot becomes detached and moves from the vein to the right side of the heart to the lodge in one or more pulmonary arteries (Qadan et al 2008, p.655). This process is what is referred to as PE. It causes shortness of breath, bloody sputum, pain in the chest, heart failure, as well as fainting (NMHRC 2009, p.11). (Royal Australian College of General Practitioners 2006, p.72 Swift and effective diagnosis and treatment of DVT is essential as it assist a medical practitioner to prevent thrombus extension, swelling of the leg, death as a result of massive PE, and eventual degeneration of the problem into the post-thrombotic syndrome (The Australian and New Zealand Working Party on the Prevention of Venous Thromboembolism n.d., p. 3). Review of current practice for prevention/ treatment of DVT pre and post-op. Prevention is better than cure. Therefore, it is advisable for both the patients and the health fraternity to put in place measures to ensure that chances of DVT is prevented from occurring (Tooher et al. 2005, p.399). At the same time, these measures should address the chances of mild DVT developing into severe DVT (Palareti et al. 2006, p.22). According to results of surveys carried out, there is laxity in following the extensive guidelines on prevention and treatment of VTE. This argument is supported by the The Australian and New Zealand Working Party on the Prevention of Venous Thromboembolism which states that one of the reasons for laxity in following the evidence is as a result of the way the current approaches tend to focus on the acute management of deep venous thrombosis, rather than its prevention and chronic sequel (n.d. p. 4). For effective treatment of DVT, it is imperative to treat patients according to their individual risks, their clinical condition, the bleeding risk and the appropriateness of the treatment/medication for the individual patient (Palareti et al. 2006, p.23). There exist various practises for the treatment of DVT (Warwick et al 2007, p.804). These options include pharmacological agents (anticoagulants and mechanical methods). These two can be used as a combination of the two or used in isolation. Adequate hydration and early mobilization are some of the simple measures that are applied as standard practise to prevent VTE (Qadan et al 2008, p.656). They combine effectively with mechanical and pharmacological methods. The effectiveness of these approaches is pegged on the clinical procedure and patient risk factors (NMHRC 1999, p. 15). In the health fraternity of Australia, the commonly used pharmacological agents are the heparins (low molecular weight heparin and unfractionated heparin sodium), fondaparinux, subcutaneously administered danaparoid, warfarin, and a vitamin K antagonist which is administered orally and orally administered aspirin a platelet inhibitor (NMHRC 1999, p. 15). Graduated compression stockings are known for their ability to reduce incidence of DVT (Qadan et al 2008, p.657). This is a mechanical device that is worn on the leg to provide prevention of DVT (Fordyce & Ling 2006, p.47). They exist in two forms, one for DVT prophylaxis and the other one for treatment of CVI. It is recommended that graduate compression stockings should be worn continuously during the period of immobility to the return of full, ambulation, the patient should comply with the fitting instructions and that they should be fitting on the individual patient (Fordyce & Ling 2006, p.48). The other approach of treating DVT is use of intermittent pneumatic compression (Pitto et al. 2007, p.640). This approach reduces incidences of DVT to a greater deal. It confers a greater degree of effectiveness in comparison to graduated compression stockings in high-risk patients (Pitto et al. 2007, p.641). This is achieved when used in combination with anticoagulants or more so, when these coagulants are contradicted. Best practice recommendations The most recommended approach is that one of combining pharmacological and mechanical approaches. This involves combining agents such as subcutaneous heparin with general compression stockings and/or intermittent pneumatic compression. Such an approach may be more effective than a single intervention alone (Bergqvist 2007, p.972). What strategies are in place within Queensland Health to reduce the risk of DVT? Some of the strategies that have been put in place to reduce the risk of DVT include the pharmacological and mechanical approaches (National Health and Medical Research Council 2009, p.43). These strategies are used individually or as a combination. In the first instance, a clinician can opt to use pharmacological agents such as low molecular weight heparin, fondaparinux, and rivaroxabin and dabigatran etexialate when carrying out a surgery type such as total hip replacement. This help to reduce significantly the risk of DVT posed to a patient (NHRMC 2009, p.2). The other strategy involves use of mechanical devices such as general compression stockings and/or intermittent pneumatic compression to reduce the risk of DVT. Discuss evidence based practice Evidence based practise is an approach to decision making that has pervaded all facets of healthcare in Australia (p2). According to Metz, Espirirtu and Moore (2007, p. 1), evidence based practise refers to the application of the best available research evidence in the provision of health, behaviour, and education services to enhance positive outcome. The concept has its origin in the field of medicine; hence, it is widely applied in the health profession. In evidence based practise, thousands of randomized controlled trials have been conducted and most incorporated into direct practises with the patients. At the clinical level, the approach lays much emphasis on the integration of high quality research evidence with clinical expertise and patient’s values (Bennet et al. 2007, p. 2). Bennet et al. further outlines, that evidence based approach calls for clinicians to access, appraise and integrate research literature as one of the core sources of informing clinical decisions (2007, p.2 ). Its impact has been widely felt in the clinical domain, prompting its applications in other disciplines such as management, policy and purchasing (Bennet et al. 2007, p. 2). Evidence based practises entails skills, techniques, and strategies which are used by medical/health practitioners when interacting with DTV patients (Metz, Espirirtu and Moore, 2007, P2). The importance of this approach in treatment of DTV is that it ensures that practises applied meet the most stringent criteria set (Rossi 2009, p.45). Such criteria include model programs or practises, exemplary programs or practises, demonstrated effective programs or practises and those that meet evidence standards. Most health agencies in Australia use different names to specify the most rigorous tested programs (National Institute of Health and Clinical Excellence 2008, p.37). However, they share most of the criteria outlined above. This ensures that most theory-based practises are experimentally tested using randomized controlled trials and reported in peer reviewed medical journals (Metz, Espirirtu & Moore, 2007, p2). Current policies and procedures in QLD Health Quite a number of policies and procedures exist in the Queensland Department of health (Rossi 2009, p.53). One of the best examples of such a policy was developed after the Venous Thromboembolism, Prevention Policy Summit of May 2010 (NHMRC 2011, p. 1). This policy (commonly known as the VTE prevention policy 2010) was a recommendation made by all jurisdictions which had been brought together to agree on a policy to prevent hospital-related VTE. The policy statement sought to adopt approaches and procedures necessary for removal of barriers to effective management of VTE and DVT (National Institute of Health and Clinical Excellence 2007, p.77). It focuses on ensuring that the VTE prevention continues to be addressed at a national and state policy level (NHMRC 2011, p. 1). The policy looked into various approaches and guidelines in prevention and treatment of VTE and related conditions. The National Institute of Clinical Studies in 2008-2009 developed a guideline known as the Clinical Practise Guideline for the Prevention of Venous Thromboembolism in Patients Admitted to Australian Hospital 2009. The summaries of this guideline which were drawn after the 2010 summit provides useful resources that continues to guide clinicians and patients in prevention and treatment of VTE, DVT and PE (NHMRC 2011, pp. 1,2&3). cost to the health system Deep Vein Thrombosis (DVT) is a costly condition to manage (National Institute of Health and Clinical Excellence 2007, p.52). It is projected that the condition may cost the Australian healthcare system over 200 million dollars yearly (Metz, Espirirtu & Moore 2007, p.51). Despite this outrageous cost, the healthcare department in Queensland has a bigger responsibility to handle DVT related cases. The main reason for the high costs of treatment of DVT is that there is little focus on prevention. According to the Australian & New Zealand Working Party on the Management and Prevention of Venous Thromboembolism, current approaches tend to focus on prevention of DVT rather than its prevention and chronic sequel (n.d. p.4). 2.0. Data collection methods. Data was collected by carrying out a literature review of relevant secondary materials on deep vein thrombosis which is readily available on the websites of Queensland Health, Australian nursing and midwifery and Royal collage of nursing. This method was preferred as there exist a high quality literature in the field of DVT, and hence, it was possible to provide an academically fit analysis of the study topic. The researcher considered these publications posted on theses websites to be best as they fit the criteria for a high quality source guideline. 3.0 Analysis of data. There is a 100 times likelihood of hospitalised patients to develop DVT and PE in comparison the rest of the community. It is approximated that over 30,000 of Australians are hospitalised with VTE. Out of these, about 2,000 succumb to VTE related conditions such as PE and DVT (Metz, Espirirtu & Moore 2007, p. 2). This accounts for about 10% of all hospital deaths in Australia. Most of these VTE cases are related to previous hospital admissions for surgery. DVT occurs in over 50% of some categories of hospitalised patients if prophlysis is not used. It is estimated that 1% of all hospital admissions succumb to death as a result of this condition (The Australian and New Zealand Working Party on the Prevention of Venous Thromboembolism n.d., p. 4). 4.0 Conclusions In conclusion, it is imperative to note that DVT is a serious condition that results after a theatre operation (Royal Australian College of General Practitioners 2006, p.72. Medical practitioners need to be careful when handling surgical operations in the theatre to reduce cases of DVT. There is need for full implementation of the Clinical Practise Guideline for the Prevention of Venous Thromboembolism in Patients Admitted to Australian Hospital 2009 (NHRM, 2011, p.7). This will enable both the clinicians and patients to reduce the risks posed by DVT after a surgery. Furthermore, measures should be put in place to ensure that there is familiarization of VTE and DVT guidelines. These guidelines ought to be included in the senior and junior medical staff orientation, hospital grand rounds and hospital newsletters ((The Australian & New Zealand Working Party on the Management and Prevention of Venous Thromboembolism, n.d. p.10). Clinical diagnosis and treatment of DVT and PE should be accurate. This can be confirmed through objective investigations (p.10). 4.1 Recommendations This report recommends the adoption of the policy statement which was recommended in the Venous Thromboembolism, Prevention Policy Summit of May 2010 (NHMRC, 2011). It further recommends the use of a combination of the pharmacological and mechanical approaches in the reduction of risks posed by DVT after a theatre operation (p.7). However, in doing so, there is need for the application of the guidelines which are provided in the QLD Health websites as well as the national guidelines on DVT (The Australian & New Zealand Working Party on the Management and Prevention of Venous Thromboembolism, n.d. p.10). In the use of graduated compression stockings, they should be measured and fitted for each patient (The Australian & New Zealand Working Party on the Management and Prevention of Venous Thromboembolism, n.d. p.5). 5.0 Reference list Bennet, S., et al. 2007. ‘Perceptions of Evidence Based Practice: A Survey of Australian Occupational Therapists’, Australian Occupational Therapy Journal, vol.50, pp. 13- 22. Bergqvist, D. 2007. Low molecular weight heparin for the prevention of venous thromboembolism after abdominal surgery. Br J Surg, 91(8):965-74. Carter, T. & Dunston, L. 2007. Perth & Western Australia. Sydney: Lonely Planet. Fordyce, M. & Ling, R. 2006. A venous foot pump reduces thrombosis after total hip replacement. J Bone Joint Surg Br, 74(1):45-9. Metz, A., Espiritu, K. & Moore, A. 2007. ‘What is Evidence-Based Practice? ‘Viewed 16th March 2012, http://www.childtrends.org/files/child_trends-2007_06_04_rb_ebp1.pdf Mylne, L. 2008. Frommer's Australia 2009. Sydney: HEMI Publishers. National Health and Medical Research Council (NHMRC) 2009. Clinical Guideline for the Prevention of Venous Thromboembolism in Patients Admitted in Australian Hospitals. Melbourne: National Health and Research Council. National Health and Medical Research Council 2009. How to use the evidence: assessment and application of scientific evidence. Melbourne: National Health and Research Council. National Health and Medical Research Council 2011. Venous Thromboembolism Prevention Policy Summit May 2010: Summary Report. Melbourne: National Health and Research Council. National Institute of Health and Clinical Excellence 2007. Venous Thromboembolism – Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. Melbourne: National Health and Research Council. National Institute of Health and Clinical Excellence 2007. Venous Thromboembolism – Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. Melbourne: National Health and Research Council. National Institute of Health and Clinical Excellence 2008. Final scope of the guidelines for prevention of venous thromboembolsim (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. Melbourne: National Health and Research Council. Palareti, G. et al. 2006. Postoperative Versus Preoperative Initiation of Deep-Vein Thrombosis Prophylaxis with a Low-Molecular-Weight Heparin (Nadroparin) in Elective Hip Replacement. Clinical and Applied Thrombosis/Hemostasis. 2(1):18-24. Pitto, R. et al. 2007. Mechanical prophylaxis of deep-vein thrombosis after total hip replacement a randomised clinical trial. J Bone Joint Surg Br, 86(5):639-42. Qadan, M. et al 2008. Venous thromboembolism inelective operations: balancing the choices. Surgery, 144(4):654-6. Rossi, S. 2009. Australian Medicines Handbook. Adelaide: HEMI Publishers. Royal Australian College of General Practitioners 2006. Australian family physician. Sydney: Lonely Planet. The Australian & New Zealand Working Party on the Management and Prevention of Venous Thromboembolism, 4th edn n.d., Prevention of Venous Thromboembolism. Sydney: HEMI Publishers. Tooher, R. et al. 2005. A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals. Ann Surg, 241(3):397-415. Warwick, D. et al 2007. Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the Global Orthopaedic Registry. 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