Effect of a Dash Board Teaching
Programme on Venous Thromboembolism
(VTE) Risk Assessment Compliance among Primary Care Nurses in an Urban Tertiary
Care Hospital
Mrs. Sujitha Elavally1*,
Mrs. S. Usha2, Mrs. S. Ramya3
1Lecturer,
Sri Ramachandra College of Nursing, Porur, Chennai- 600 116.
2Nurse Level-
I, Sri Ramachandra Medical Centre, Porur, Chennai- 600 116.
3Nurse Level-
II, Sri Ramachandra Medical Centre, Porur, Chennai- 600 116.
*Corresponding
Author Email: sujithaajith@yahoo.co.in
ABSTRACT:
Venous
thromboembolism is a common and serious complication
among hospitalised patients.VTE incidence increases
the hospital stay and thus the cost of treatment. Staff nurses play an
important role in the risk assessment, prophylaxis and prevention of VTE. Their
knowledge on VTE largely influences the successful VTE prevention programme. The aim of the study was to assess the effect of
a dash board teaching programme on the risk
assessment compliance among staff nurses. A retrospective audit of in-service
department files was conducted to assess the intervention and outcome measures.
The audit included the laptop assisted teaching, post-test knowledge of nurses
on VTE and their compliance on VTE assessment. The approach was descriptive.
The instruments used were a 10 item knowledge questionnaire and a 24 item VTE
risk assessment tool. Descriptive and inferential statistical methods were used
for data analysis. The result showed that the knowledge of staff nurses and
risk assessment compliance was good. There was a positive correlation between
compliance and knowledge among staff nurses.
KEY WORDS: venous thromboembolism,
prevention, prophylaxis, staff nurses, knowledge, teaching, compliance.
INTRODUCTION:
VTE is a major and serious cause of death and
disability among chronic, immobile hospitalised
patients. (Rahim et al., 2003)1. It broadly represents a clot in the
blood vessel and includes two conditions- deep vein thrombosis and pulmonary
embolism. The number of patients getting admitted with risk factors for VTE is
rising in the current scenario. The other identified risk factors are surgery,
prolonged anesthesia, advanced age, dehydration etc. The common prophylactic
measures employed for VTE are chemical, mechanical or combined methods.
Presence of bleeding
risk prevents the usage of chemical prophylaxis, and in such situations
mechanical methods are adopted. According to Dixon,
et al.(2015)2, the cumulative incidence of VTE within
90 days of surgery was 3.29% among major ortho
surgery patients. Baser
et al. (2012)3 identified
that prophylaxis significantly reduced the incidence
of VTE compared with no prophylaxis (0.06% vs 3.44%, respectively; P <.00001) and increased the
median time to VTE (182 vs
27 days, respectively) among a group of medical patients.
Sincere VTE risk
assessment and application of suitable prophylaxis and treatment among patients
can reduce VTE incidence (Nutescu, 2007)4.
The employment of
appropriate prophylactic methods for VTE purely depends on a thorough patient
assessment which in turn will influence the development of VTE. This assessment
is primarily and essentially completed by nurses as they are the first point of
contact of care. These assessment findings and score is utilised
to communicate the risk to the consultants and employment of appropriate
prophylaxis. Nursing care and knowledge of nurses on VTE prevention will
influence the likelihood of development of VTE.
The VTE prevention programme and staff nurse teaching was incorporated into the
routine inpatient support programme of the hospital
as a response to the scattered incidence of VTE especially among critical care
patients.
STATEMENT OF THE PROBLEM:
A study to assess effect of a planned
teaching programme on VTE risk assessment compliance
among primary care nurses in an urban tertiary care hospital (from 27 areas).
OBJECTIVES:
1.
To assess the
knowledge of staff nurses on VTE
2.
To assess the
compliance of risk assessment of staff nurses on VTE
3.
To correlate the
knowledge with compliance of risk assessment
Fig 1: Hospital VTE prevention initiative
MATERIALS AND METHODS:
Study
Design:
A descriptive study design was used.
Retrospective chart audit of in-service education department records was
conducted to assess the knowledge of staff nurses on VTE and compliance of risk
assessment.
Sample
size
The cumulative population
of 540 primary care staff nurses of 27 patient care areas were the
samples. The in-service education department has maintained the VTE risk
assessment compliance of these staff nurses for a period of three months after
the teaching. This was collected from the records of their assigned patients.
These data were utilised for the study with the
permission of hospital management and nursing department. Ethical guidelines
were followed for conducting the study.
Intervention
(Dash board teaching):
The teaching module consisted of
information on meaning, causes, risk factors, pathophysiology,
signs and symptoms, management and method of prevention of VTE for the staff
nurses. It was a 30 min group intervention conducted by a trained VTE
specialist nurse with the aid of laptop projector.
Description
of the tool:
The self administered knowledge
questionnaire consisted of ten items on various aspects of VTE based on the
lesson plan. The maximum score was 10.
The risk assessment tool is a modified
one which contained 24 items on various VTE risk factors like age, chronic
illness, surgery, bleeding disorders, acute illnesses etc. The score of 12 and
above was considered high risk, 8-12 moderate and <8 low risk. The items are
ticked by the primary care nurses on admission or whenever the patient’s
condition changed by asking questions to the patient, from past records,
initial doctor assessment and report from relatives. The compliance was
assessed by the frequency of timely complete filling of the risk form and categorisation by the staff nurse for all the patients
under their care.
Data
collection procedure:
The teaching and assessment were carried
out among the staff nurses in the wards and intensive care areas. The post-test
knowledge score on VTE of staff nurses and compliance of risk assessment were
assessed one week after the planned teaching programme.
The post assessment values were collected over a period of three weeks. The
total duration of the intervention- post assessment was one month. Back ground
information about the staff nurses were also collected from the in-service
files.
Methods
of data analysis:
Descriptive and inferential statistical
methods are used for the analysis of data. Descriptive methods included
frequency, percentage, mean and SD. Inferential methods included correlation
coefficient to assess the interrelationship between the knowledge on VTE, risk
assessment compliance and developed VTE.
Scoring
and interpretation:
The knowledge and compliance of the staff
nurses are graded as good (>75%), average (50-75%) and poor (>50 %). The
total knowledge scores of all the staff nurses in the particular care area was
averaged and graded. Compliance was
calculated from the percentage of total number of patients assessed for VTE
risk by all the staff nurses during three weeks in a selected care area and
graded.
RESULTS:
Out of the 540 staff nurses assessed, 25%
were graduates and the rest were diploma holders. 12% had > 5yrs of patient
care experience, 46% had 3-5 years of experience and the rest had experience of
< 3yrs. 40.4% were intensive care nurses. The overall knowledge of staff
nurses on VTE was good (85.2%, SD 19.23). The overall compliance on risk assessment
was good (83.70%) with mean 24.68 and SD 4.41. There was a weak positive
correlation between the knowledge and risk assessment compliance (r= 0.125)
among staff nurses. The educational preparation and the years of experience of
staff nurses were associated with their compliance of risk assessment.
DISCUSSION:
The planned teaching programme
ensured that the knowledge of staff nurses was good on VTE (85%). This knowledge largely influenced their
risk assessment compliance also (r=0.125). The findings were similar to the
report given by Li et al., (2010)5 who conducted a web based survey
among 221 patient care nurses on their knowledge on VTE and frequencies of risk
assessment. Most of the nurses reported their knowledge as good and fair. The
knowledge level positively correlated with their risk assessment frequencies
and VTE preventive care.
It was evident from the in-depth and
continued analysis of the records that poor compliance in turn has contributed
to development of VTE among patients at risk. This teaching initiative must be
motivated by the administrators and nurse leaders. Additional teaching for the
low scorers and spot education with routine reinforcement was also employed in
case of poor compliance. Dash board approach identified the knowledge gaps.
Sensitization programmes are the key factor for
improving the compliance and such initiatives need to be promoted in the
clinical set up.
REFERENCES:
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Baser, O.,
Sengupta, N., Dysinger, A. and Wang, L. Thromboembolism
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Dixon, J., Ahn,
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in Patients Undergoing Major Hip and Knee Joint
Surgery at Waitemata District Health Board (WDHB) : A
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Nutescu, E.A.. Assessing, preventing, and treating venous thromboembolism: evidence-based approaches. Am J Health Syst
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Rahim, S.A., Panju,
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Received on 16.05.2015 Modified
on 18.06.2015
Accepted on 26.06.2015 © A&V Publication all right reserved
Asian J. Nur. Edu. and Research 5(4): Oct.-
Dec.2015; Page 492-494
DOI: 10.5958/2349-2996.2015.00113.5