American Journal of Nursing Research
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American Journal of Nursing Research. 2019, 7(6), 974-982
DOI: 10.12691/ajnr-7-6-10
Open AccessArticle

Effect of Educational Intervention on Critical Care Nurses' Adherence to the Clinical Practice Guidelines for Preventing Venous Thromboembolism in Critically Ill Patients

Naglaa EL Mokadem1, and Shimaa EL-Sayed1

1Assistant Professor of Critical Care Nursing, Lecturer of Critical Care Nursing, Critical Care Nursing Department, Menoufia University

Pub. Date: October 07, 2019

Cite this paper:
Naglaa EL Mokadem and Shimaa EL-Sayed. Effect of Educational Intervention on Critical Care Nurses' Adherence to the Clinical Practice Guidelines for Preventing Venous Thromboembolism in Critically Ill Patients. American Journal of Nursing Research. 2019; 7(6):974-982. doi: 10.12691/ajnr-7-6-10


Background: Critically ill patients are at high risk for developing DVT. The prevalence of DVT and PE is underestimated in the ICU, as it is often clinically silent, especially in sedated and mechanically ventilated patients. ICU acquired thromboembolic events are difficult to diagnose, as they may mimic many other diseases. Identifying patient populations at risk for DVT and implementing evidence-based guidelines can decrease the number of unpleasant effects of this disease. Although the supporting evidence about the beneficial effect of the clinical guidelines has been in place for a long time, the guidelines have been greatly underused. Aim: To examine the effect of educational intervention on critical care nurses' adherence to the clinical practice guidelines for preventing venous thromboembolism in critically ill patients. Methods: Design: A quasi-experimental design (pre/post test) was used. Setting: The study was conducted at different ICUs at Menoufia University Hospital, Shebin El-Kom district, Menoufia Governorate. Sample: A convenience sample of 192 critical care nurses working at different ICUs who provide direct nursing care to critically ill patients at Shebin El-Kom, Menoufia University Hospital were recruited for this study. Nurses participated in the study were approached over an eight week period. One hundred and sixty-seven nurses participated in the study. Novel nurses who have less than 6 months experience in ICU were excluded because they did not have enough experience about clinical practice guidelines for DVT prevention. Three tools were used for data collection: a) Demographic sheet; b) Availability of DVT Prevention Clinical Practice Guidelines and c) The Clinical Nurses Practice Guidelines of DVT Prevention Observational Checklist (CNPG). Results: Clinical practice guidelines for DVT prevention is not available in the ICUs and the participated nurses have not been oriented or received any information about the practice guidelines. As a consequence, they are not implementing the guidelines in their daily practice. Also, there was a statistically significant improvement in the critical care nurses’ adherence to the clinical practice guidelines for preventing DVT post-intervention compared with pre-intervention. Recommendations: Accurate individualized assessment of VTE risk is critical to optimize prophylaxis. VTE risk assessment and prophylaxis recommendations should be integrated into hospital protocols, to be easier for nurses to comply with guidelines than if they are not standard practice.

venous thromboembolism clinical practice guidelines DVT prevention strategies nursing intervention

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[1]  DeMuro JP, Hanna AF. (2013). Prophylaxis of Deep Venous Thrombosis in Trauma Patients: A Review. J Blood Disorders Transf 4:151.
[2]  Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, (2012). Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141: e227S-77S.
[3]  Cohen MJ, West M (2011). Acute traumatic coagulopathy: from endogenous acute coagulopathy to systemic acquired coagulopathy and back. J Trauma .70: S47-49.
[4]  Minet, C., Potton, L., Bonadona, A., Hamidfar-Roy, R., Somohano, C. A., Lugosi, M., Timsit, J. (2015). Venous thromboembolism in the ICU: main
[5]  Centers for Disease Control and Prevention. (2016). Characteristics, diagnosis and thromboprophylaxis. Critical Care, 19 (1). Venous thromboembolism (blood clots).
[6]  McLeod, A. G., & Geerts, W. (2011). Venous thromboembolism prophylaxis in critically ill patients. Critical care clinics, 27 (4), 765-780.
[7]  Songwathana P, Promlek K, and Naka K, (2011). Evaluation of a clinical nursing practice guideline for preventing deep vein thrombosis in critically ill trauma patients. Australasian Emergency Nursing Journal. Volume 14, Issue 4, November 2011, Pages 232-239
[8]  Geerts WH,Heit JA, Clagett P, et al. (2001).Prevention of thromboembolism. Chest; 119: 132S-175S.
[9]  Geerts WH, Pineo GF,Heit JA, et al. (2004). Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest;126(3 Suppl): 338S-400S.
[10]  Abdel-Aziz, A., & Elfawwal, M. A. (2015). Incidence of deep venous thrombosis in stroke patients in medical intensive care unit Zagazig University Hospitals, Egypt. Zagazig University Medical Journal, 20(1), 88-96.
[11]  Gaspard D, Vito K, Schorr C, et al. (2016). Comparison of chemical and mechanical prophylaxis of venous thromboembolism in nonsurgical mechanically ventilated patients. Thrombosis. 2015; 2015: 849142. Epub 2015 Nov 22. Accessed July 15, [level C]
[12]  Lilly CM, Liu X, Badawi O, Franey CS, Zuckerman IH. (2014). Thrombosis prophylaxis and mortality risk among critically ill adults. Chest. 146(1):51-57.
[13]  Barrera LM, Perel P, Ker K, et al (2013). Thromboprophylaxis for trauma patients. Cochrane Database Syst Rev. 3:CD008308. [level A].
[14]  Ho KM, Tan JA (2013). Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation. 128(9): 1003-1020. [level A].
[15]  Wan B, Fu HY, Yin JT, et al (2015). Low-molecular-weight heparin and intermittent pneumatic compression for thromboprophylaxis in critical patients. Exp Ther Med. 10(6): 2331-2336. [level C]
[16]  Bhatti A, Ahsin S, Salim B , Mansoor J (2012). Knowledge, Attitude And Practices Of Healthcare Providers Towards Deep Vein Thrombosis Prophylaxis In Five Teaching Hospitals of Rawalpindi Ayub Med Coll Abbottabad ; 24(2): 136-139.
[17]  Galbraith, E. M., Vautaw, B. M., Grzybowski, M., Henke, P. K., Wakefield, T. W., & Froehlich, J. B. (2010). Variation in physician deep vein thrombosis prophylaxis attitudes and practices at an academic tertiary care center. Journal of Thrombosis and Thrombolysis, 30(4), 419-425.
[18]  Hunt B and Thomas A and Retter S. (2010). The Intensive Care Society: Standards And Guidelines Venous Thromboprophylaxis in Critical Care.
[19]  Lilly CM, Liu X, Badawi O, Franey CS, Zuckerman IH. (2014). Thrombosis prophylaxis and mortality risk among critically ill adults. Chest; 146(1): 51-57.
[20]  Ho KM, Chavan S, Pilcher D. (2011). Omission of early thromboprophylaxis and mortality in critically ill patients: multicenter registry study. Chest;140(6):1436-1446.
[21]  Hong KC, Kim H, Jang YK, et al. (2012). Risk factors and incidence of deep vein thrombosis in lower extremities among critically ill patients. J Clin Nurs; 21: 1840-1846.
[22]  Douketis, J. D., Spyropoulos, A. C., Spencer, F. A., Mayr, M., Jaffer, A. K., Eckman, M. H., (2012). Perioperative management of antithrombotic therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2 Suppl), e326S-50S.
[23]  Gharaibeh, L., Albsoul-Younes, A., & Younes, N. (2015). Evaluation of venous thromboembolism prophylaxis after the introduction of an institutional guideline: Extent of application and implementation of its recommendations. Journal o f Vascular Nursing, 33(2), 72-78.
[24]  Krell, R. W., Scally, C. P., Wong, S. L., Abdelsattar, Z. M., Birkmeyer, N. J., Fegan, K., Hendren, S. (2015). Variation in hospital thromboprophylaxis practices for abdominal cancer surgery. Annals of Surgical Oncology. Advance online publication.
[25]  Passman, M. (2010). Mandated quality measures and economic implications of venous thromboembolism prevention and management. The American Journal of Surgery, 199(1S), 21-31.
[26]  [Antony M., Moly K., and Dharan R. (2016). Assessment of Knowledge and Self Reported Clinical Practice on Prevention of Deep Vein Thrombosis (DVT) Among Staff Nurses. Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 5, Issue 1 PP 18-24.
[27]  Stinnett JM, Pendleton R, Skordos L, Wheeler M, Rodgers GM. (2005). Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates. Am J Hematol; 78(3): 167-172.
[28]  Sahu, R., Menon, S., Anik, S., Rai, A., (2017). A study to assess the effectiveness of planned teaching program on knowledge and clinical practice regarding Deep Vein Thrombosis among B. Sc. Nursing intern’s working in Jawaharlal Nehru Hospital and Research Centre Bhilai (C.G.) Int. J. Nur. Edu. and Research.; 5(3): 272-278.
[29]  Ah-Lee, J., Grochow, D., Drake, D., Johnson, L., Reed., P., Servellen, G., (2014). Evaluation of hospital nurses' perceived knowledge and practices of venous thromboembolism assessment and prevention. Journal of Vascular Nursing. Volume 32, Issue 1, Pages 18-24.
[30]  Yu HT, Dylan ML, Lin J, Dubois RW. (2007). Hospital’s compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Sys Pharm; 64: 69-76.
[31]  Collins, L. Mac Lellan, H. Gibbs, D. MacLellan, J. Fletcher. (2010). Venous Thromboembolism prophylaxis: The role of the nurse in changing practice and saving lives, Australian Journal of Advanced Nursing. Vol. 27, No. 3, 83-9.