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

Abstract

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.