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Impact of The Problem on The Patient Assignment

Impact of The Problem on The Patient Assignment

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According to Yu, Wu, and Ning (2021),

“Deep venous thrombosis (DVT) is a common complication after hip arthroplasty, with an incidence rate of 40–60 %. The formation of DVT of the lower extremities can increase the suffering of patients, prolong hospitalization time, and increase medical expenses.”

Impact of the Problem on the Organization

According to Salomomn, Dasa, Krause, Hall, and Chapple (2021), Impact of The Problem on The Patient Assignment

“Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a well-recognized complication of total joint arthroplasty (TJA) that may result in longer hospital length of stay (LOS), higher rates of recurrent VTE and hospital readmission, increased medical costs, and greater mortality.”

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Identify the PICO components

P –Total hip replacement orthopedic patients

I –Early Ambulation

C –Ambulation after 6 hours of anesthesia end time

O –Decreased number of patients diagnosed and treated for deep vein thrombosis.

 

Evidence Based Practice Question

Does early ambulation (within 6 hours of anesthesia end time) in patients that have had total joint replacement surgery on hips decrease the incidence of being diagnosed and treated for deep vein thrombosis (DVT) as compared to not implementing early ambulation?

 Research Article

Yu, Wu, and Ning (2021), study shows:

“Deep venous thrombosis (DVT) is a common complication after hip arthroplasty, with an incidence rate of 40–60 %[7]. The formation of DVT of the lower extremities can increase the suffering of patients, prolong hospitalization time, and increase medical expenses. Once it falls off, it can easily cause pulmonary embolism, and severe cases can lead to death.” Impact of The Problem on The Patient Assignment

This is the main reason I want to help educate my PACU staff on the negative aspects of not ambulating total hip arthroplasty patients after their surgery. I am the PACU Charge nurse, and we recover total joint replacement surgeries daily and some days we hold these patients in PACU for several hours just waiting on a bed assignment.

Background Introduction

The purpose of this evidence-based practice study is to determine if early ambulation prevents deep vein thrombosis in total hip replacement patients.

Methodology

The methodology used was primary with meta-analysis.

Level of Evidence

Level III quantitative retrospective methodology

Data Analysis

Test used to analyze the data were chi-squared test, t-test, and logistic regression analysis.

Ethical Considerations

In this primary study methods were performed and all the included patients had signed the written informed consents and ethical approval. Impact of The Problem on The Patient Assignment

Quality Rating

Good quality rating-B

Analysis of the Results / ConclusionsAccording to the research article: The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care Deep venous thrombosis (DVT) is a common complication after hip arthroplasty, with an incidence rate of 40–60 %. The article also      states that patients who remained bed ridden for >/ 3 days were at significantly higher risk of developing DVT’s. All the articles I have researched push for patients to ambulate as soon as possible after surgery to prevent DVT’s.

 

Non-Research Article

The following statement is from Yu, Wu, and Ning (2021), “Early mobilization Patients should be mobilized as soon as possible following surgery…This is supported by level 1 evidence that early mobilization reduces length of stay (Guerra et al. 2015). This counteracts the long-recognized adverse physiological effects associated with prolonged bed rest such as increased insulin resistance, muscle atrophy, reduced pulmonary function, impaired tissue oxygenation, and increased risk of thromboembolism (Harper and Lyles 1988). Impact of The Problem on The Patient Assignment

Background Introduction

This review put together detailed information form several peer reviewed sites such as nih.gov and ebscohost.com. The grounds of this review was to talk through some of the latest literature and how it relates to early mobilization of the total hip arthroplasty patient may decrease post operative deep vein thrombosis diagnosis and complications.

Type of Evidence

The articles mainly used statistical data as their type of evidence.

Level of Evidence

Level IV Consensus statement

Quality Rating

Good Quality-B

 

Author’s Recommendations

Early ambulation is a vital key opponent in post operative total hip replacement patients to decrease the incidence of DVT/VTE’s and other post operative complications in this patient population. Educating the staff regarding these findings and improving patient care/outcomes should help with staff compliance, as they now have the “why” associated with the change I would like to implement. As suggested by the Consensus Statement (2020) Patients need to ambulate as soon as possible if clinically stable. This decreases post-operative complications and make discharging patients sooner a possibility. Impact of The Problem on The Patient Assignment

  

Recommended Practice Change

Both articles gave insight to support that early mobilization in post operative total hip replacements decreased the risk of developing deep vein thrombosis along with a decrease in other post operative complications.

The research article The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care supports the intervention of early ambulation to decrease DVT’s and encourages patients to get out of bed as soon as possible to decrease the incidence of being diagnosed with DVT’s

 

The non-research (Wainwright et al., 2019) article supports the intervention of early ambulation to decrease the risk of  DVT’s and states that  observation studies of fast track/ERAS (enhanced recovery after surgery) patients that ambulate sooner show thromboembolic events to be significantly reduced. Impact of The Problem on The Patient Assignment

Findings from both sources support the practice change that I have purposed to assist our post operative total hip replacement surgical patients up out of bed within 6 hours of post anesthesia end time.

 

Key Stakeholders

The first stakeholder would be The Joint Commission as they are the ones who have developed key goals and standardized performance measures that the hospital would have to be in compliance with in order to obtain orthopedic accreditation focus being on total hip and knee replacements.

The second stakeholder would be our Manager who would have to make sure we have the equipment we need in PACU to meet these standardized goals and assign the PACU staff specific dates and times of collaborative meetings with PT and other members of our ortho-fast track team to meet the education requirements and check offs.

The third stakeholder would be the nursing educator to create a class to educate our staff on how we can help to decrease DVT’s in our total joint patients by early ambulation as measured by the outcomes of before/after DVT rates. Impact of The Problem on The Patient Assignment

 

Barrier to Implementation

The main barrier I would have implementing a practice change being the charge nurse in PACU is my nursing staff being resistant to change and learning/implementing new guidelines as they feel that this is not their responsibility. They feel this should be the responsibility of the orthopedic nurses and physical therapy staff.

 

 

Strategy to Overcome the Implementation Barrier

To overcome resistance of the new practice I would want to get my team involved as much as possible so they feel they have a voice in this change as well. I believe having a few mandatory unit meetings to discuss this change prior to the “go live” date would be beneficial in decreasing the anxiety that can accompany change. I also feel that having the joint center team (nurses, PT/OT, orthopedic surgeons, etc.) available for educating PACU staff and answering questions would also help to make this transition a smooth one. Impact of The Problem on The Patient Assignment

 

Indicator to Measure the Outcome

A reduction in deep vein thrombosis will be measured after implementing these new patient goals of early ambulation post total hip replacement surgery as compared to no early ambulation post operatively.

References

Salomon, B., Dasa, V., Krause, P. C., Hall, L., & Chapple, A. G. (2021). Hospital Length of Stay Is Associated With Increased Likelihood for Venous Thromboembolism After Total Joint Arthroplasty. Arthroplasty today, 8, 254–257.e1.

Wainwright, T. W., Gill, M., Mcdonald, D. A., G Middleton, R., Reed, M., Sahota, O., Yates, P., & Ljungqvist, O. (2019). Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthopaedica, 91(1), 3–19. https://doi.org/10.1080/17453674.2019.1683790

Yu, X., Wu, Y., & Ning, R. (2021). The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care. BMC musculoskeletal disorders, 22(1), 547. https://doi.org/10.1186/s12891-021-04417-z

A professional portfolio will showcase your knowledge and skills to prospective employers and will increase your marketability as a baccalaureate-prepared nurse. This portfolio will help you, as a nurse, hone in on the concepts, strengths, and critical-thinking abilities that define professional nursing practice. Throughout your time at WGU, you have developed skills and knowledge that distinguish your practice as that of a baccalaureate-prepared nurse. Items that display your skills and knowledge will be showcased in this professional portfolio. You should organize your portfolio around the four areas of professional nursing practice: quality and safety, advanced evidence-based practice, applied leadership, and community and population health. This portfolio will expand on the portfolio you already created in your Professional Roles and Values course. Impact of The Problem on The Patient Assignment
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

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A. Complete the following in your e-portfolio using the “E-Portfolio Template” in the weblink section:

1. Create a professional mission statement (suggested length of 1 paragraph) that includes the following:

• a representation of your career goals, your aspirations, and how you want to move forward with your career Impact of The Problem on The Patient Assignment

• an overview of where you would like to focus your time and energies within the profession

a. Reflect on how your professional mission statement will help guide you throughout your nursing career.

2. Complete a professional summary (suggested length of 3–4 pages) that includes the following:

a. Explain how the specific artifacts (examples of written work completed during this program) or completed work or both in your portfolio represent you as a learner and a healthcare professional.

b. Discuss how the specific artifacts (examples of written work completed during this program) in your portfolio represent your professional strengths.

c. Discuss challenges you encountered during the progression of your program.

i. Explain how you overcame these challenges.

d. Explain how your coursework helped you meet each of the nine nursing program outcomes.

 

Note: Refer to the attachment “Nursing Conceptual Model.”

 

e. Analyze how you fulfilled the following roles during your program:

• scientist

• detective Impact of The Problem on The Patient Assignment

• manager of the healing environment

f. Discuss how you have grown professionally since the beginning of your program.

 

B. Complete the following within the section “Quality and Safety”:

1. Reflect (suggested length of 1 page) on your professional definition of quality and safety developed in Professional Roles and Values, including any necessary changes to your definition.

a. Discuss how the program assisted you in developing your professional definition.

b. Identify the artifacts in your portfolio that support your definition.

i. Explain how these artifacts support your definition from part B1.

 

Note: The artifacts should be included in your e-portfolio.

 

2. Discuss the importance of the Institute for Healthcare Improvement (IHI) certificate for your future role as a professional nurse. Impact of The Problem on The Patient Assignment

 

C. Complete the following within the section “Evidence-Based Practice”:

1. Reflect (suggested length of 1 page) on your professional definition of evidence-based practice developed in Professional Roles and Values, including any necessary changes to your definition.

a. Discuss how the program assisted you in developing your professional definition.

b. Identify the artifacts in your portfolio that support your definition.

i. Explain how these artifacts support your definition from part C1.

 

Note: The artifacts should be included in your e-portfolio.

 

2. Reflect (suggested length of 1 page) on your understanding of evidence-based practice and applied nursing research by doing the following:

a. Discuss how you are able to evaluate current primary research and apply the concepts to your nursing practice, considering the following:

• relevancy and believability of data

• differences between quality improvement and research (places and uses of each)

• differences between primary and secondary research and resources and the implications of each in clinical practice Impact of The Problem on The Patient Assignment

b. Explain how your experience in the program helped you achieve excellence in evidence-based practice.

 

D. Complete the following within the section “Applied Leadership”:

1. Reflect (suggested length of 1 page) on your professional definition of applied leadership you developed in Professional Roles and Values, including any necessary changes to your definition.

a. Discuss how the program assisted you in developing your professional definition.

b. Identify the artifacts in your portfolio that support your definition.

i. Explain how these artifacts support the definition from part D1.

 

Note: The artifacts should be included in your e-portfolio.

 

2. Summarize (suggested length of 1 paragraph to 1 page) your Learning Leadership Experience task by doing the following:

a. Discuss the importance of professional collaboration for effective nursing leadership.

 

E. Complete the following within the section “Community and Population Health”:

1. Reflect (suggested length of 1 page) on your professional definition of community and population health you developed in Professional Roles and Values, including any necessary changes to your definition. Impact of The Problem on The Patient Assignment

a. Discuss how the program assisted you in developing your professional definition.

b. Identify the artifacts in your portfolio that support your definition.

i. Explain how these artifacts support the definition from part E1.

 

Note: The artifacts should be included in your e-portfolio.

 

2. Summarize (suggested length of 1 page) your Community and Population Health task by doing the following:

a. Discuss what you learned during your Community Health Nursing task.

b. Discuss what you learned that led to your community diagnosis.

c. Discuss how your initial focus and diagnosis evolved after working with your population.

3. Discuss the importance of the American Museum of Natural History (AMNH) certificate for your future role as a professional nurse.

 

F. Provide an appendix to your portfolio by including the following deliverables:

1. Include all the documents, prior assignments, and additional items that are examples of your best work to support your mastery of all sections given in parts B, C, D, and E. Impact of The Problem on The Patient Assignment

2. Include the following materials:

• the attached “Nursing Conceptual Model”

• a link to the current IHI Course Catalog

3. Provide an updated professional résumé.

4. Provide professional references, using one of the following:

• a professional reference questionnaire

• a full letter of recommendation

• a list of four professional references with title and phone and/or email address

5. Include a copy of your IHI certificate of completion.

6. Include a copy of your AMNH certificate of completion.

 

G. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

 

H. Demonstrate professional communication in the content and presentation of your submission.

File Restrictions Impact of The Problem on The Patient Assignment

 

 

 

 

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