Nursing Utilization Project on Educational Program on VTE for Nurses
Research Support First of all, it is necessary to mention that VTE (Venous thromboembolism) is an essential public health problem with the incidence rates similar to stroke and fatality rates greater than acute myocardial infarction (Baccarelli, Zanobetti, Martinelli, 2007 ). The incidence of VTE may be markedly reduced with appropriate prophylaxis, yet prophylaxis rates are disturbingly low in clinical practice, as is emphasized in the research by Tillett (2006). To increase proper prophylaxis rates, evidence-based instructions should be elaborated developed for several high-risk patient groups to define the best approach and work out the best strategy for the process of educational program utilization.
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Taking into account the seriousness of the problem of deep vein thrombosis which originates from Pulmonary embolism, it is necessary to emphasize that it is the most preventable cause of hospital death. Zamula (1989) states the following: “pharmacologic methods to prevent VTE are safe, effective, cost-effective, and advocated by authoritative guidelines. Yet, despite the reality that hospitalized medical and surgical patients routinely have multiple risk factors for VTE, making the risk for VTE nearly universal among inpatients, large prospective studies continue to demonstrate that these preventive methods are significantly underutilized”. The elaboration of the strategy leads to the works by the Agency for Healthcare Research and Quality, which call thromboprophylaxis against VTE the “number one patient safety practice.” The American Public Health Association, in its turn, has argued that the “disconnect between evidence and execution as it relates to DVT prevention amounts to a public health crisis.” (Voda, Ashton ,2006). Unfortunately, any strategy has not been recognized as effective sustainable, and widely applicable for the treatment centers for improving the prevalence of VTE prophylaxis. Monreal (2004) arguing on the matters of strategy effectiveness argues the following: the prophylaxis of VTE syndrome is evolving rapidly, as experience with local attempts and the Society of Hospital Medicine’s Venous Thrombo Embolism Prevention collaborative are authorizing the risk evaluation approaches and implementation strategies which are represented in the programs for VTE treatment and nursing education. Anyway, one thing is obvious: to implement effective protocols which would minimize the incidence of hospital-acquired VTE, redesign is required in both care delivery and presentation tracking. (Kennedy, Polivka, Bininger, 1995). It is claimed that the ideas of the structural changes for the educational program implementation should be originated by a local management team, which would also elaborate the ways of successful management of the project. It is worth mentioning that the member of this team should be highly experienced as frontline caregivers or complementary insights. The team members (according to Imperato and Waisman, 2002) are also obliged to know the evidence grounding, local influence, or insight into care delivery. He also stated that hospitalists are the most desired candidates for such teams, which are appearing in the increasing amount of hospital systems. The evaluation of the utilization of VTE prophylaxis in medically ill patients was conducted in the research by Shojania, Duncan and McDonald (2008). This research represents another retrospective view, and it provides the estimation of the conditions of the patients with discharge. These patients were classified with the usage of the same criteria as the pre-education period patients (MEDENOX). As in the original estimation, the data were gathered patient demographics, presence of VTE risk factors, length of stay, use of VTE prophylaxis, and type of VTE prophylaxis utilized. (Harenberg, Schomaker, 2003). The results from findings in the post-education groups should be compared with the results of the pre-education groups, and thus, the general and most suitable strategy may be defined. Lots of restrictions were taken into account for this workout. As Heit (2005) states, these are the following: the initial personnel education is concentrated on nursing personnel with only one-on-one conversation with medical personnel. It is claimed that this approach is not effective, as the accent should be placed on making the education process available for every level of the medical personnel. Originally, the engagement from medical consultants and hospital personnel will not be effective during the performance of this project, as the senior personnel should guide and examine the junior staff, requiring them to perform the optimal prescribing of the treatment and prophylaxis. Implementation Plan Overall Plan The plan is aimed to conduct a pre-test on VTE and assess the present knowledge of the staff working on the Medical-surgical floor. After the pretest, the lesson plan will be developed according to the knowledge of the staff. For the prevention of VTE, the protocol of the organization and the Same VTE scale will be used to avoid any confusion among the nurses. The nurses working on the medical-surgical floor must participate in the full educational activity, complete the 10-question post-test with a score of 90% or better, and complete the evaluation form. The purpose of the research-based project is to make the awareness among the nurses working on the medical-surgical floor and increase their current knowledge related to the VTE. The nurses working on the medical-surgical floor will be made aware of evidence-based practices related to VTE. Resources Baccarelli (2007) states, that the required resources for the implementation of the plan would require a multi-angle approach. By assigning the injury prevention controller as the VTE project manager, it is necessary to ensure that the project implementation would be sustainable in the long term. Moreover, this type of management would require the professional qualification of the manager in the sphere of medical treatment of VTE, and experience in dealing with medical personnel, as the VTE committee should also stay active and deal with different groups of patients.
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Methods for Monitoring The monitoring process should be arranged based on periodic reports and regular meetings, with the discussion of the achievements, failures, and mistakes of the project in general and separate team members in particular. It is considered, that this type is the most effective, however, it requires additional time resources, as at least two hours a week should be spent for monitoring and discussion. Ways of Plan Implementation The theory was used for the direct planning of the implementation process. Originally, a theoretical base was gathered for the evaluation of the problem and finding the ways for its solution. Then, theoretical approaches were transferred into the practical perspective. Consequently, the way of the planned change implementation was originally grounded on the theoretical approaches. Feasibility of the implementation plan It is necessary to mention that the plan was elaborated by taking into account the previous experience and the possible mistakes of the innovative approaches. Thus, it looks rather feasible, however, for the objective and detailed evaluation it is necessary to see the results and analyze the received data. References Baccarelli, A., Zanobetti, A., Martinelli, I., Grillo, P., Hou, L., Lanzani, G., et al. (2007). Air Pollution, Smoking and Plasma Homocysteine. Environmental Health Perspectives, 115(2), 176 Imperato, P. J., Waisman, J., Wallen, M., Pryor, V., Rojas, M., Giardelli, K., et al. (2002). Results of a Cooperative Educational Program to Improve Prostate Pathology Reports among Patients Undergoing Radical Prostatectomy. Journal of Community Health, 27(1), 1 Kennedy, C. W., Polivka, B. J., Bininger, C. J., Sears, J. R., & Voorhees-Murphy, S. (1995). Evaluating a Mental Health Education Program for Community Health Nurses. Journal of Community Health Nursing, 12(4), 221-228. Heit J.A, Cohen A.T, Anderson F.A, Jr, (2005) “VTE Impact Assessment Group. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US”. Blood.;106:267a. Abstract 910. Harenberg J, Schomaker U, Flosbach CW.(2003) Enoxaparin is superior to unfractionated heparin in the prevention of venous thromboembolic events in medical patients at increased thromboembolic risk [abstract]. Blood.;94 (suppl 1):399a. Monreal M, Kakkar A, Caprini J, et al. (2004) The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients. Findings from the RIETE registry. J Thromb Haemost 2004;2:1892-8. Shojania K. J, Duncan B. W, McDonald K. M, Wachter R. M, Markowitz A. J. (2001) Making health care safer: A critical analysis of patient safety practices. Evid Rep Technol Assess (Summ).2001;(43):i-x, 1-668. Tillett, T. (2006). Continuing Education for Nurses on venous thromboembolism. Environmental Health Perspectives, 114(7), 410. Voda, A. M., & Ashton, C. A. (2006). Fallout from the Women’s Health Study: A Short-Lived Vindication for Feminists and the Resurrection of Hormone Therapies. 401 Zamula, E. (1989, November). Pulmonary Embolism: Difficult but Crucial Diagnosis. FDA Consumer, 23, 22