Your patient asks you to remove his compression devices. What do you do?
It’s 2200. The room is quiet. You peek in for your purposeful hourly rounding check. The patient is awake, so you ask if his pain remains managed. You help reposition him, perform your safety checks, ensure he doesn’t need to use the bathroom, and get him settled for sleep. You ask, “Is there anything else I can do for you before I check on you again in a hour?” His request is common: “The things squeezing my legs are annoying. Can we take them off?”
What do you do?
Deep vein thrombosis (a blood clot in a deep vein) and pulmonary embolism (a clot that travels to the lung) together are called venous thromboembolism. VTE is one of the most common preventable causes of hospital-related morbidity and mortality, affecting as many as 900,000 Americans every year and resulting in 100,000 premature deaths.
Every year, our clinical teams review cases where VTE may be a contributing factor in patient harm. There is strong evidence that pharmacologic interventions such as anticoagulation and nonpharmacologic interventions such as ambulation and intermittent pneumatic compression devices (IPCs) can prevent most blood clots in the hospital — if they are used for the right patients, in the right way, at the right time.
Despite these relatively straightforward interventions, blood clot prevention is complicated. Providers must tailor prophylaxis strategies to each patient by considering their risk factors and contraindications. To help guide nurses through some of these individualized considerations, a VTE prevention guide was developed and is now available on myAsanteNET.
The guide focuses on managing VTE for pediatric and adult hospitalized patients and identifies pharmacologic and nonpharmacologic interventions to guide appropriate treatment of the patient and their condition. This guide:
- Reviews related definitions and terms.
- Identifies care team roles and responsibilities for prevention and treatment.
- Identifies VTE prophylaxis considerations.
- Outlines nursing assessment.
- Reviews patient education.
- Identifies steps to address patient refusal of ordered interventions.
Back to our patient. We know identifying risk (which can change over the course of a hospitalization) and prevention is critical to avoid hospital-acquired VTE. Removing the IPCs upon request may increase the risk of VTE and lead to preventable morbidity or mortality. For patients who decline ordered prophylaxis, the nurse must provide ongoing education regarding prevention strategies and assess individual risk factors. Concerns regarding patient compliance with the plan of care or recommendations for alternative strategies based on changing risk factors should be escalated to the provider team.
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