J Korean Acad Nurs Adm.  2017 Jan;23(1):63-75. 10.11111/jkana.2017.23.1.63.

Adaptation and Effects of the Evidence-based IPC Nursing Protocol on Prevention of Postoperative Venous Thromboembolism

• Kim NY
• Kim EA
• Sim JY
• Jung SH
• Kim HY
• Jang EH
• Shin JH

• KMID: 2369520
• DOI: http://doi.org/10.11111/jkana.2017.23.1.63

Abstract

PURPOSE
This study was conducted to adapt the standardized evidence-based nursing protocol using the IPC (intermittent pneumatic compression) intervention to prevent venous thromboembolism in surgical patients. Further, an investigation was done to measure knowledge on prevention of venous thromboembolism, surrogate incidence of venous thromboembolism and to assess IPC compliance in the study patients compared with those in surgical patients who underwent IPC intervention due to previous clinical experience.
METHODS
An analysis was done of the nine modules suggested by National Evidence-based Healthcare Collaborating Agency (NECA) in the adaptation manual of the clinical practice guideline for protocol adaptation. A nonequivalent control group post test design as a quasi-experiment was used to verify the effect of the IPC protocol.
RESULTS
There was a significant difference in knowledge of prevention of venous thromboembolism, IPC application time after intervention and the number of IPC applications between the experimental group (n=50) using the IPC nursing protocol and the control group (n=49). However, the symptoms of deep vein thrombosis and pulmonary thromboembolism were not observed in either the experimental group or the control group after the intervention.
CONCLUSION
Results confirm that the standardized IPC nursing protocol provides effective intervention to prevent venous thromboembolism in surgical patients.

Keyword

Evidence-based nursing; Practice guideline; Intermittent pneumatic compression devices; Venous thromboembolism; Surgical procedures operative

MeSH Terms

Compliance
Evidence-Based Nursing
Evidence-Based Practice
Humans
Incidence
Intermittent Pneumatic Compression Devices
Nursing Assessment*
Nursing*
Pulmonary Embolism
Venous Thromboembolism*
Venous Thrombosis

Reference

1. Streiff MB, Brady JP, Grant AM, Grosse SD, Wong B, Popovic T. CDC Grand Rounds: Preventing hospital-associated venous thromboembolism. MMWR Morb Mortal Wkly Rep. 2014; 63(9):190–193.

2. Michota FA. Bridging the gap between evidence and practice in venous thromboembolism prophylaxis: The quality improvement process. J Gen Intern Med. 2007; 22(12):1762–1770. DOI: 10.1007/s11606-007-0369-z.

3. Piazza G, Goldhaber SZ. Venous thromboembolism and atherothrombosis: An integrated approach. Circulation. 2010; 121(19):2146–2150. DOI: 10.1161/circulationaha.110.951236.

4. Spencer FA, Emery C, Joffe SW, Pacifico L, Lessard D, Reed G, et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis. 2009; 28(4):401–409. DOI: 10.1007/s11239-009-0378-3.

5. Sweetland S, Green J, Liu B, Berrington de, Canonico M, Reeves G, et al. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: Prospective cohort study. BMJ. 2009; 339:b4583. DOI: 10.1136/bmj.b4583.

6. Maynard G. Preventing hospital-associated venous thromboembolism: a guide for effective quality improvement. 2nd ed. AHRQ Publication No. 16-0001-EF [Internet]. Rockville, MD: Agency for Healthcare Research and Quality;updated August 2016. cited 2016 October 7. Available from: https://www.ahrq.gov/sites/default/files/publications/files/vteguide.pdf.

7. Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost. 2011; 9(1):85–91. DOI: 10.1111/j.1538-7836.2010.04108.x.

8. Bang SM, Jang MJ, Kim KH, Yhim HY, Kim YK, Nam SH, et al. Prevention of venous thromboembolism. 2nd ed. Korean society of thrombosis and hemostasis evidence-based clinical practice guidelines. J Korean Med Sci. 2014; 29(2):164–171. DOI: 10.3346/jkms.2014.29.2.164.

9. Yun JS, Kim EO, Park HJ, Moon KH, Seo YS, Kim LY, et al. Knee versus thigh length anti-embolic stockings for prevention of deep vein thrombosis in postoperative surgical patients: Evidence-based practice implementation. Evid Nurs. 2013; 1(1):25–32.

10. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuunemann HJ. Executive summary: Antithrombotic therapy and prevention of thrombosis. 9th ed. American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012; 141:2 Suppl. 7S–47S. DOI: 10.1378/chest.1412S3.

11. Scottish Intercollegiate Guidelines Network. Prevention and management of venous thromboembolism [Internet]. Edinburgh: Scottish Intercollegiate Guidelines Network;2010. cited 2010 December 12. Available from: http://www.sign.ac.uk/guidelines/fulltext/122/index.html.

12. Yoon JH, Lee IS, Lee KY, Jang MJ, Lee JM, Nam MS, et al. Development of the prevention guideline of deep vein thrombosis in patients with surgery according to the guideline adaptation process. J Korean Clin Nurs Res. 2014; 20(3):337–347.

13. Kim H, Cho OM, Cho HI, Kim JY. [This article has been retracted] Risk factors and features of critically ill patients with deep vein thrombosis in lower extremities. J Korean Acad Nurs. 2012; 42(3):396–404. DOI: 10.4040/jkan.2012.42.3.396.

14. Domeij-Arverud E, Labruto F, Latifi A, Nilsson G, Edman G, Ackermann PW. Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation: a prospective randomised trial of acute ruptures of the Achilles tendon. Bone Joint J. 2015; 97-B(5):675–680. DOI: 10.1302/0301-620X.97B5.34581.

15. Koo KH, Choi JS, Ahn JH, Kwon JH, Cho KT. Comparison of clinical and physiological efficacies of different intermittent sequential pneumatic compression devices in preventing deep vein thrombosis: a prospective randomized study. Clin Orthop Surg. 2014; 6(4):468–475. DOI: 10.4055/cios.2014.6.4.468.

16. Kim JS, Kim HJ, Woo YH, Lym JY, Lee CH. Effects on changes in femoral vein blood flow velocity with the use of lower extremity compression for critical patients with brain injury. J Korean Acad Nurs. 2009; 39(2):288–297. DOI: 10.4040/jkan.2009.39.2.288.

17. Korean Society of Thrombosis and Hemostasis. Japan venous prevention recommendations some modifications according to local real one [Internet]. Seoul: The Korean Society on thrombosis and hemostasis;2009. cited 2016 October 12. Available from: http://www.thrombo.or.kr/popup/100817/pop_100817.html.

18. Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997; 350(9094):1795–1798. DOI: 10.1016/s0140-6736(97)08140-3.

19. Lee JM. Risk factors of lower extremity deep venous thrombosis in postoperative patients [master's thesis]. Seoul: The Catholic University of Korea;2014.

20. Elpern E, Killeen K, Patel G, Senecal PA. The application of intermittent pneumatic compression devices for thromboprophylaxis: AN observational study found frequent errors in the application of these mechanical devices in ICUs. Am J Nurs. 2013; 113(4):30–36. quiz 37. DOI: 10.1097/01.naj.0000428736.48428.10.

21. Turner T, Misso M, Harris C, Green S. Development of evidence-based clinical practice guidelines (CPGs): Comparing approaches. Implement Sci. 2008; 3:45. DOI: 10.1186/1748-5908-3-45.

22. Gu MO, Cho Y, Cho MS, Eun Y, Jeong JS, Jung IS, et al. Adaptation of intravenous infusion nursing practice guideline. J Korean Clin Nurs Res. 2013; 19(1):128–142.

23. Kim SY, Choi MY, Shin SS, Ji SM, Park JJ, Yoo JH, et al. Handbook for clinical practice guideline developer (version 1.0) [Internet]. Seoul: National Evidence-based Healthcare Collaborating Agency;2015. cited 2015 November 9. Available from: http://www.neca.re.kr/center/researcher/book_view.jsp?boardNo=CA&seq=9436&q=626f6172644e6f3d4341.

24. Kim SY, Kim NS, Shin SS, Ji SM, Lee SJ, Kim SH, et al. Manual for guideline adaptation(version 2.0). Seoul: National Evidence-based Healthcare Collaborating Agency;2011.

25. National Clinical Guideline Centre for Acute and Chronic Conditions (GB). National Institute for Health and Clinical Excellence (GB). Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. National clinical practice guideline, vol 92. London: National Clinical Guideline Centre for Acute and Chronic Conditions;2010.

26. Gaston S, White S, Misan G. Venous thromboembolism (VTE) risk assessment and prophylaxis: a comprehensive systematic review of the facilitators and barriers to healthcare worker compliance with clinical practice guidelines in the acute care setting. JBI Libr Syst Rev. 2012; 10(57):3812–3893.

27. Lynn MR. Determination and quantification of content validity. Nurs Res. 1986; 35(6):382–385. DOI: 10.1097/00006199-198611000-00017.

28. Kurtoğlu M, Güloğlu R, Ertekin C, Taviloglu K, Alimoglu O. Intermittent pneumatic compression in the prevention of venous thromboembolism in high-risk trauma and surgical ICU patients. Ulus Travma Acil Cerrahi Derg. 2005; 11(1):38–42.

29. CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): A multicentre randomised controlled trial. Lancet. 2013; 382(9891):516–524. DOI: 10.1016/S0140-6736(13)61050-8.