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.
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.
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).
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:
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.
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 patientís 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.
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.
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.
1. Baser, O., Sengupta, N., Dysinger, A. and Wang, L. Thromboembolism prophylaxis in medical inpatients: effect on outcomes and costs, Am J Manag Care. Jun;18(6): 2012: 294-302.
2. Dixon, J., Ahn, E., Zhou, L., Lim, R., Simpson, D. and Merriman, E.G. Venous Thromboembolism (VTE) Rates in Patients Undergoing Major Hip and Knee Joint Surgery at Waitemata District Health Board (WDHB) : A Retrospective Audit. Intern Med J..Feb 2: 2015. doi: 10.1111/imj.12702. [Epub ahead of print]
3. Li F, Walker K, McInnes E and Duff J. Testing the effect of a targeted intervention on nurses' compliance with "best practice" mechanical venous thromboembolism prevention. J Vasc Nurs. Sep; 28(3): 2010: 92-6.
4. Nutescu, E.A.. Assessing, preventing, and treating venous thromboembolism: evidence-based approaches. Am J Health Syst Pharm. Jun 1; 64(11 Suppl 7): 2007:S5-13.
5. Rahim, S.A., Panju, A., Pai, M. and Ginsberg, J. Venous thromboembolism prophylaxis in medical inpatients: a retrospective chart review. Thromb Res.; 111(4-5): 2003: 215-9.
Received on 16.05.2015††††††††† Modified on 18.06.2015
Accepted on 26.06.2015 †††††††† © A&V Publication all right reserved