Show:
Protocol
Evidence-Base
DVT
Compression
Need to Know
100
The department that usually puts the protocol in the chart
What is radiology
100
What was the old way to manage a DVT in acute care?
What is bed rest and elevation. Why? it was believed that ambulation would cause a patient to throw a PE.
100
pain, swelling, redness, warmth in LE
What are the signs & symptoms of DVT
100
The role of compression stockings for the DVT patient
What is to prevent and relieve symptoms of Post Thrombotic Syndrome (PTS): chronic pain, swelling, discoloration, valvular incompetence -even venous ulcers. 50% of DVT patients end up with PTS
100
Definition: Aims to apply the best evidence gained from scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests.
What is Evidence Based Medicine? -this protocol is Evidence-Based !!
200
In the protocol, the test that is performed in radiology after diagnosis of DVT is confirmed by ultrasound, that determines if a patient has adequate blood supply to be eligible for the protocol/compression
What is an ABI- Ankle Brachial Index
200
What group of medical professionals changed the standard of care by researching the evidence base on DVT treatment and writing new guidelines of care in 2008?
What is The American College of Chest Physicians (ACCP). The guidelines are in their publication CHEST.
200
The clinical best practice pathway that can be enacted upon physician order, once a patient is diagnosed with DVT?
What is the Protocol for Ambulation and Compression
200
20-30 mm Hg
What is level of compression stockings WMC uses
200
If a DVT patient is anticoagulated, and the physician has screened the patient for possible contraindications, then we know that early ambulation and compression is _____
What is safe and/or best practice
300
If protocol is enacted, which department is responsible for applying the compression stockings and evaluating the patient for ambulation/mobility?
What is Physical Therapy
300
What conclusions did the CHEST guidelines draw about the safety of ambulation after a DVT
What is that it is safe, as long as the patient has is on anticoagulants. Research showed that ambulation did not result in greater incidence of fatal PEs
300
DVT stands for this:
What is deep vein thrombosis?
300
If the MD does not want the patient ambulating, can the patient just wear the stockings to prevent PTS?
What is Yes. -If the physician indicated it was safe to apply compression and he orders 20-30 mmHg compression outside of the protocol. Order needed. MD would want to still consider having ABI to make sure circulation is good enough to tolerate compression.
300
A patient on the protocol needs to have a follow up visit at 30 days post discharge to this type of healthcare provider for compression stocking reassessment
What is Outpatient Occupational Therapy
400
The location of the protocol for ambulation and compression, in case anyone needs to find it to be placed on the chart
What is the intranet, under Protocols
400
What does the research show is an effective way to reduce the risk of development of post-thrombotic syndrome
What is compression therapy
400
The other DVT protocol- involves DVT prohylaxis- TED hose/SCD and medication
What is DVT/PE Prevention Orders?
400
The way that the therapy staff determine the right stocking size for the patient
What is measuring the length and girth (ankle, calf, thigh) of the leg
400
This is what nursing should do when the MD gives a verbal order to "begin DVT Protocol"
What is put the protocol on chart and complete the verbal order signature line, flag for the MD to sign
500
Say the protocol has failed to show up on the chart- who is best suited to pick up on this and get the protocol on chart?
Who is Nursing. (they should: Place protocol on chart and ask MD to consider patient as candidate- question each other on handoff communications if patient is on protocol)
500
Where is a good location to find the referenced research articles that support this protocol?
What is the care path
500
It is located in WMC Policies and Procedure Manual >WMC Patient Care Manuals>section 04 General Nursing>
What is the Policy & Procedure for the DVT Protocol for Ambulation and Compression
500
The frequency the stockings must be removed by nursing for skin checks
What is BID or once per shift
500
Radiology only places protocol on chart for inpatients that are positive for DVT. What should nursing do if patient is admitted directly or from ED and already diagnosed with acute DVT (direct admit)?
What is place protocol on chart and discuss with MD