Critique of a Study on an Intervention for Venous Thromboprophylaxis

The purpose of this paper is to review a journal article on venous thromboprophylaxis and a suggested intervention for nurses working with patients with this ailment. The paper will critique the problem in practice, the credibility of the authors, the significance of the problem in health care, the strength of the research evidence, links to national standards, and potential cost reduction. Lastly, methods to transmit this information to nurses will be discussed as well as a method for evaluation.

What is the problem in practice?

What is the best nursing and physician intervention for improving venous thromboprophylaxis in elderly patients? Keywords: nursing, venous thrombosis, aged 65 and older, randomized control trial, post-acute, practice guidelines.

What is the author's credibility?

The credibility of the authors is determined by whether they collaborated with other disciplines, their level of education, and whether the study was funded by a grant. The authors' credentials are not listed by their names, so it is difficult to know their levels of education or discipline. The hospitals where each author works were listed. However, as the study is assessing the effectiveness of interventions for both physicians and nurses, it can be assumed that there is cross-collaboration within the study. The study was "funded by a grant from the French Ministry of Health. Ultrasound systems were provided by Sonosite France" (Labarere, Bosson, Sevestre, Sellier, Richaud, & Legagneux 2007, p. 307). The funding by grand helps to raise credibility.

How significant is the problem to healthcare as a whole?

The study does not state any previous studies and in fact explains that there is limited evidence for the usefulness of elastic stockings to minimize fluid retention, and there are no existing randomized trials for keeping patients bedridden (Labarere et al., 2007, p. 301). Venous thromboembolisms are common in older patients who are hospitalized, so this study provides important information on interventions for nurses treating patients with thrombosis.

What is the strength of the evidence?

This study provides evidence that the most effective interventions for deep vein thrombosis in patients over 65 years old include "the use of elastic stockings, ambulation or mobilization of bed-ridden patients, and anticoagulant-based thromboprophylaxis" (Labarere et al., 2007, p. 303). The strengths of the evidence include the statistics in the results. The results show that the multifaceted interventions targeting nurses resulted in higher rates of mobilization than interventions targeting only physicians. Additionally, the sample size is significant at 812 patients.

One weakness of the study is that that many patients did not like the compression stockings, therefore they did not want to use them and skewed the effectiveness of this intervention. Another weakness is that most studies of this type are directed at physicians, and the effectiveness of interventions cannot necessarily be transferred to nurses. Lastly, eight of the facilities studied dropped out of the study before completion.

What national benchmark is most relevant for this subject?

Functional benchmarking, an external measure of best practice, is most relevant for this study. The study is comparing various interventions for venous thromboprophylaxis across 45 different organizations, and it is studying the most effective practice rather than competition.

What cost reduction will your intervention bring?

The use of compression socks is a very inexpensive way to reduce thromboprophylaxis. Compression socks generally cost between $15-30 and are easily obtained. Helping to mobilize patients does not cost anything other than the cost of the staff to help with physical therapy.

How will you implement and evaluate the project?

In order to implement these interventions, it is crucial to educate practitioners, both physicians, and nurses, on the methods, effectiveness, and results. Nurses should have the study explained to them in order to see how the use of compression stockings, mobilization, and anti-coagulation medications directly benefit patients with venous thromboprophylaxis. Bringing in a trainer who is specialized in these interventions would help nurses have a chance to practice mobilization techniques and how to put compression stockings on a patient. This also allows for any questions to be asked and concerns to be addressed. This can be done in a team meeting setting that is separated from the work environment so that nurses can fully focus on the information being received. It would be helpful to also educate the nurses on how each of the interventions is helpful for patients. Seeing how these benefits patients will inspire nurses to learn and implement the procedures.

This will be best evaluated by receiving both practitioner and patient feedback. Nurses can provide feedback on how well they were trained and educated on the interventions and whether there were any troubles implementing them. Additionally, statistics on patients can provide information on the effectiveness, particularly feedback about the process and results of rehabilitation.

Reference

Labarere, J., Bosson, J., Sevestre, M., Sellier, E., Richaud, C., & Legagneux, A. (2007). Intervention targeted at nurses to improve venous thromboprophylaxis. International Journal for Quality in Health Care, 19(5), 301-308.