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1. BSN Program Student Learning Outcome (PSLO) #2: provide safe, competent, and effective nursing care to patients throughout the lifespan.

2. BSN Program Student Learning Outcome (PSLO) #6: apply research findings to promote evidence-based practice (EBP).

Development of venous thromboembolism(s) postoperatively, as a result of prolonged immobilization, is a preventable complication found in hospitalized patients. In an effort to decrease incidences of VTE, nurses are responsible for providing patients with safe and effective nursing care in conjunction with evidence-based care to prevent these occurrences. Nurses can continue to do their due diligence by following hospital wide VTE protocols, initiating goal setting with the patient and their family, institution of patient teaching, etc. The conduction of research surrounding the topic of DVT prevention in postoperative patients, has led to the adoption of evidence-based practices/care in the healthcare setting today. These concepts learned at Sentara College of Health Sciences (SCOHS) has prepared me to take on a leadership role by highlighting the importance of utilizing EBP in the deliverance of patient care.

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1. VTE prophylactic protocols in healthcare facilities

Development and utilization of hospital-wide VTE protocols can avoid increased hospital stays and lower healthcare costs. VTE protocols should include how early, how vigorous, and how often autonomous or assisted ambulation should occur to prevent VTE (ex. DVT or PE) (Lau et al., 2020).

2. Adherence to pharmacological prophylaxis

If a patient refuses pharmacological intervention(s), the nurse should institute patient teaching on why it is important to take antiplatelet or anticoagulant medications whilst hospitalized. Inclusion of easy to interpret pamphlets, videos, one-pagers, etc. should be provided to all patients at risk for developing a blood clot. To prevent re-hospitalization, every patient should receive appropriate discharge teaching to prevent another incidence of VTE postoperatively. This can be done by thoroughly explaining the signs and symptoms of a VTE, providing instructions on what to do and who to call if experiencing symptoms, pamphlets on lifestyle changes, etc.

Goal Setting This can be done by establishing rapport and ensuring comfortability, the interdisciplinary team can intervene and provide significant improvements in patient outcomes, compliance, and overall patient satisfaction postoperatively. Motivating patients to participate in their care by encouraging questions about how often they should exercise, how to prevent VTE, signs and symptoms of a DVT, lifestyle changes, medication compliance, the use of compression stockings, etc.

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Barriers and challenges nurses face during the implementation of VTE prophylactic measures include:

Refusal of pharmacologic regimens (ex. anticoagulants, antiplatelets)

Refusal of mechanical prophylaxis (ex. ambulation, foot-leg exercises, sequential compression device (SCD), compression stockings, etc.)

Psychological post-thrombotic panic

According to Al-Mugheed et al., (2023), patients often reported long-term concerns and panic related to the cause of VTE and the adaptation of prophylaxis decides (para. 31).

The lack of professional competence

Nurses not instituting the application of SCD's or lack of VTE prevention measures among nurses, which obstructs effective patient care (Al-Mugheed et al., 2023).

Prolonged hospital stays and increased healthcare costs have a direct correlation to a lack of VTE prophylactic measures instituted by nurses (Al-Mugheed et al., 2023).

The inability to provide patients with antiplatelet drugs due to bleeding or clotting disorders (ex. hemophilia).

Inadequate nurse-patient ratios may lead to the nurses inability to prioritize patient ambulation (Al-Mugheed et al., 2023).

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Why the Nurses's Involvement Is Important

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Why the Nurses's Involvement Is Important

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As nurses, it is important to establish rapport and encourage patients to set goals concerning the status of their health. This could help provide the patient with a sense of autonomy, control, and comfortability when making decisions regarding their health. By establishing rapport and ensuring comfortability, the interdisciplinary team can intervene and provide significant improvements in patient outcomes, compliance, and overall patient satisfaction postoperatively. These desired results require synchronized functionality between the patient and interdisciplinary team members.

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In an effort to decrease the incidences of developing a VTE in patients postoperatively, nurses first establish rapport to collaboratively set ambulation goals with the patient(s). Another way nurses aid in the prevention of blood clots, is by utilizing the teach back method when conducting discharge teaching and providing easy to comprehend pamphlets to patients. Nurses encourage questions regarding how often one should exercise postoperatively, the use of compression stockings, signs and symptoms of a blood clot, and lifestyle changes that can be made to support the prevention of blood clots. As nurses, it is essential to educate patients on why adherence to mechanical prophylaxis in conjunction with anticoagulation regimens, are a necessity postoperatively. Placing emphasis on repositioning routinely, ambulation postoperatively, and the need for regular leg movements, etc. will continue to help maintain optimal venous status and reduce the risk of developing a DVT (March et al., 2017).

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Issue: Development of Deep Vein Thrombosis Postoperatively

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Issue: Development of Deep Vein Thrombosis Postoperatively

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Have you or a loved on suffered from a blood clot while hospitalized or post hospitalization? Surgery is inherently a trigger for a venous thromboembolism, as is prolonged immobilization (Talec et al., 2016). Venous thromboembolism (VTE) encompasses the spectrum of manifestations of deep vein thrombosis and/or pulmonary embolism and is a common, serious, and preventable complication is hospitalized patients (Chindamo et al., 2019). A deep vein thrombosis is described as a blood clot that forms in the deep veins of the body including areas of the leg(s), pelvis, or arm(s); whereas a pulmonary embolism is a blood clot that blocks blood flow to an artery in the lung. The classic triad of Virchow, defined by the combination of venous stasis, endothelial alteration, and a hypercoagulable state, is universally present post-operatively explaining a higher incidence of VTE than is seen in the general population (Talec et al., 2016).

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1. Upon conducting my research, I came across a systemic review titled "Effectiveness of ambulation to prevent venous thromboembolism in patients admitted to the hospital". The research concluded that a significant decrease in VTE were shown when implementing a hospital-wide ambulatory protocol. This was conducted by offering autonomous ambulation for hospitalized patients with documentation of how long, how frequent, and the length the patient ambulated in an effort to decrease instance of a VTE (Lau et al., 2020).

2. A second research article titled "Role of ambulation to prevent venous thromboembolism in medical patients: where do we stand?", went on to find that defining immobility is of great importance when assessing mobility status and risk for for the development of blood clots (VTE). By creating a standardized definition of "immobility" across the board, hospitals can implement the necessary screening tools and ambulatory protocols, while also decreasing mortality rates in high risk patients (Chindamo et al., 2019).

3. A third research article titled "Early ambulation and prevention of post-operative thrombo-embolic risk", went on to discuss prevention measures in postoperative patients at risk for VTE. Research showed an 84% reduction in deep vein thrombosis (DVT) after institution of a mechanical prophylaxis in conjunction with prescribed pharmacological thromboprophylaxis (Talec et al., 2016).

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Talec, P., Gaujoux, S., & Samama, C. M. (2016). Early ambulation and prevention of post-operative thrombo-embolic risk. Journal of Visceral Surgery, 153(6). https://doi.org/10.1016/j.jviscsurg.2016.09.002

Chindamo, M., & Marques, M. (2019). Role of ambulation to prevent venous thromboembolism in medical patients: Where do we stand?. Jornal vascular brasileiro. https://pubmed.ncbi.nlm.nih.gov/31360151/

Lau, B. D., Murphy, P., Nastasi, A. J., Seal, S., Kraus, P. S., Hobson, D. B., Shaffer, D. L., Holzmueller, C. G., Aboagye, J. K., Streiff, M. B., & Haut, E. R. (2020, December 8). Effectiveness of ambulation to prevent venous thromboembolism in patients admitted to hospital: A systematic review. CMAJ open. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7743906/

March, P. (2017, December 1). Deep Vein Thrombosis: Prevention -- an Overview. https://research.ebsco.com/c/w35cs5/viewer/html/kuvre4srmn

Al-Mugheed, Khalid, et al. “Nursing Care and Barriers for Prevention of Venous Thromboembolism in Total Knee and Hip Arthroplasty Patients: A Qualitative Study.” Journal of Multidisciplinary Healthcare, vol. Volume 16, Feb. 2023, pp. 547–556, https://doi.org/10.2147/jmdh.s403383.