Venous Thromboembolism Prophylaxis Guidlines: Risk assessment and ICU Nurses’ Knowledge, Practice, Facilitators and Barriers

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Salman, Mazen
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Mazen Salman
Introduction: Venous thromboembolism (VTE) is a constellation of deep vein thrombosis (DVT) and pulmonary embolism (PE). Millions of patients around the world are affected by VTE, which is responsible about thousands of hospitalizations. VTE could be preventable for patients who are hospitalized to decrease morbidity and mortality. Appropriate VTE prophylaxis for hospitalized medical and surgical patients is frequently omitted or delayed despite of the wide recognition of its importance. Possible explanations for delay can be explored in the context of situational awareness of nurses who represent the largest component of the health care team. Perform critical tasks like patient assessment, surveillance, and what they do or fail to do is directly related to patient outcomes Aim: The aim of the present study is to assess the level of knowledge of ICU nurses towards VTE guidelines among ICU nurses and to recognized facilitators and barriers for implementing guideline prophylaxis in addition to identify patients at risk for VTE using risk assessment model (RAM) Method: Quantitative Descriptive, cross sectional design was used in this study including two populations; nurses and patients. The numbers of participating nurses were 91 nurses working in ICU and CCU. Also, 101 patients were included in the study which carried out in four hospitals. Rafedia hospital, Nablus hospital, Arabic hospital and AL-estishary hospital. Questionnaires were distributed to nurses included five parts; the demographic data, questions related to VTE nurse’s knowledge, questions related to VTE guidelines practice, questions related to VTE perceived facilitators and questions related to VTE perceived barrier for guidelines implementation among ICU nurses. RAM (Caprini score) was used to identify patients at risk of VTE admitted to ICU with length of stay more than 24 hours. Follow up had been done for these patients by telephone after three months by asking about any complication occurred such as DVT, PE or death. Results: Out of nurse’s total sample, 69.2% of participants are male while 30.8% are female. Majority (67%) of nurses had less than 5 years’ experience. Most of the participants have bachelor degree (72.53%). Regards previous educational courses about VTE, 64.8% of nurses had no previous course, and only 35.2% did have. According to nurses’ level of knowledge regarding VTE, the study results revealed a statistically significance lower level than average (p value=0.003). Furthermore, the regression test between the dependent variable (Total VTE knowledge score) and the independent variables (hospital, gender, age, the department, the education degree, years of experience and Previous VTE education course), revealed that all independent variables had no statistical significant except previous VTE education course (p value. = 0.001). According to ICU nurse adherence level to VTE practice, mean was 2.26 out of 3 ± 0.30. Nurses ranked “nurses reminders to physician about VTE prophylaxis” as the highest perceived facilitators to implement VTE prophylaxis guidelines, while “Lack of educational courses about VTE prophylaxis” as the highest perceived barrier to implement VTE prophylaxis. Out of the total patients’ sample, 58.4% are male, while 41.5% are female with average age 62.5 years .The average weight is 82.03 kg. According to question “does Caprini score detect complications?”, the p value for gender and weight in relation to complication is not statistically significant. On the other side, age is statistically significant (p value=0.001) which mean that the person is 1.129 times more likely to have complications in each year difference. The levels of Caprini score in relation to complication has been found to be statistically significant (p value=0.004). 87 patients had no complication with 11.94 mean of Caprini score and 14 patients had complication with 19.35 mean of Caprini score. Conclusion: ICUs nurses are in need for continuous education and training regarding to VTE prophylaxis guidelines based on findings of the present study. Nurses’ knowledge was insufficient among ICU nurses about pulmonary embolism and deep vein thrombosis (VTE) and VTE prophylaxis guidelines, which is responsible for many hospitalization complications. Furthermore, there were lack of policies utilization regarding VTE guidelines in the selected hospitals which might be related to some barriers and raised the need for adoption of RAM in the ICUs. Finally, there was a positive relation between increasing in patient age and having more complication based on Caprini score.
Venous Thromboembolism Prophylaxis Guidlines: Risk assessment and ICU Nurses’ Knowledge, Practice, Facilitators and Barriers