Cost of Healthcare, Quality Management/Risk Management & Patient Safety

You are assigned to develop an evidence-based practice guideline for postoperative joint replacement venous thromboembolism (VTE) prevention. The current practice in your facility varies greatly among the physicians and nurses. Some physicians order anticoagulants, whereas others order sequential compression devices (SCDs). Some nurses perform passive range of motion every 2 hours; others turn the patient every 2 hours. Ideally, the outcome will be a standardized protocol for all joint replacement patients concerning prevention of VTE interventions. The initiative rose from a 25% increase in VTEs among joint replacement patients over the past year.

1. Define the practice problem.

2. Go to the AHRQ website (www.ahrq.gov/clinic/epcix.htm) and look for information on VTE prevention in postoperative joint patients. What guidelines are available? Is there evidence to support interventions?

3.Clinical practice guidelines should be evaluated prior to being implemented into practice. One freely available tool is the AGREE tool, which provides specific steps for evaluating clinical practice guidelines. Go to the website AGREE website https://www.agreetrust.org/resource-centre/agree-ii/ and download the AGREE tool. Use the tool to evaluate the clinical practice guideline you selected for VTE prevention. Look in a medical-surgical text for information on VTE prevention. List the interventions supported. Are they different or the same as the information you obtained from the website? Evaluate the sources of evidence from the website and the text. How recent is the information? Is the supporting evidence from research, or is it based on expert opinion?

4. Develop a basic practice guideline using the evidence you have obtained.

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