Proposed Solution in Managing Deep Venous Thrombosis and Pulmonary Embolism
HI, requested you since you wrote my last paper, so I can't keep same so that writer knows topic. This Week 3 paper . Same topic from last time DVT and heparin use with Total Knee replacement
Consider the population in which the solution is intended, the staff that will participate, and the key contributors that must provide approval and/or support for your project to be implemented. These stakeholders are considered your audience.
Develop an implementation plan (1,500-2,000 words) using the "Topic 3: Checklist" resource. The elements that should be included in your plan are listed below:
1 Method of obtaining necessary approval(s) and securing support from your organization's leadership and fellow staff.
2 Description of current problem, issue, or deficit requiring a change. Hint: If you are proposing a change in current policy, process, or procedure(s) when delivering patient care, describe first the current policy, process, or procedure as a baseline for comparison.
3 Detailed explanation of proposed solution (new policy, process, procedure, or education to address the problem/deficit).
4 Rationale for selecting proposed solution.
5 Evidence from your Review of Literature in Topic 2 to support your proposed solution and reason for change.
6 Description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)
7 Resources required for implementation: staff; educational materials (pamphlets, handouts, posters, and PowerPoint presentations); assessment tools (questionnaires, surveys, pre- and post-tests to assess knowledge of participants at baseline and after intervention); technology (technology or software needs); funds (cost of educating staff, printing or producing educational materials, gathering and analyzing data before, during, and following implementation), and staff to initiate, oversee, and evaluate change.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
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Institution
Date
Developing an Implementation Plan
Introduction
Deep Venous Thrombosis and Pulmonary Embolism are two of the common postoperative complications for patients who undergo total knee replacement. Many surgeons are faced with orthopedic problems concerning postoperative especially for patients who do not use prophylaxis. Although low-molecular-weight heparin is considered as a safe prophylaxis in preventing the two postoperative complications, the main concern is how to minimize risks of bleeding associated with LMWH (Sheth, Lieberman, & Valle, 2010). Problem Description
Several studies indicate the increased prevalence rate of deep vein thrombosis after knee arthroplasty among the adult population. Currently, the prevalence rate of thromboembolism has increased from 40 – 84 percent especially for patients who do not use prophylaxis (Giannoni, et al. 2009). Multiple orthopedic procedures are performed yearly including knee and hip replacement risking the lives of many people. These procedures activate blood clotting increasing the risk of venous thromboembolism especially for patients who do not use prophylaxis (Nocolaides et al., 2010). Thromboembolism is becoming an international health concern. According to international medical experts, PE is considered to be fatal but often overlooked. DVT leads to post-thrombotic venous insufficiency and ulceration that in turn impacts on the quality of life increasing the overall health cost (Nocolaides et al., 2010).
Despite concerns being raised about the risk of bleeding due to LMWH, several studies prove that LMWH is much safer than the other regime. One of the studies suggests that one daily subcutaneous injection of calcium nadroparin in a fixed weight-adjusted dosage scheme had greater impact compared to pneumatic. Furthermore, studies prove that LMWH is more effective in patients using warfarin and LMWH as prophylaxis. Patients given warfarin or LMWH had significantly lower prevalence of DVT and PE compared to patients using unfractionated heparin. The study confirms that low molecular weight heparins are more effective compared to other regimens after arthroplasty (Wang et al., 2011).
Several measures have been established to reduce the risk of VTE, medical experts agree that to reduce bleeding; the best option is to maximize the efficacy of VTE prophylaxis exploiting the advantages of each of them. The medical experts further support the superior efficacy and the safety of low molecular weight heparins (LMWHs). Numerous clinical trials prove that Nadroparin thromboprophylaxis reduces the incidences of DVT by 87 percent, according to the study, Nadroparin thromboprophylaxis did not show any risk of bleeding (Thirugnanam, Pinto, Cook, Geerts, & Fowler, 2012). Obtaining Necessary Approval and Securing Support from Your Organization's Leadership
Ensuring the proposal is approved and supported by all the stakeholders in the hospital is the main step towards reducing the increasing incidences of deep venous thrombosis (DVT) and pulmonary embolism for patients who undergo total knee replacement. It is important to follow the systematic procedures of approval process as indicated in the hospital guidelines. Obtaining approval from all the people in charge of different departments will ensure support is gained from across all the relevant people especially departmental heads, who are charged with the responsibility of approving and supporting initiatives that offer quality care to patients. Ensuring information reaches other staff, proper information channels should be adhered to concerning the proposed plan of using LMWH as the preferred choice. Advocating for low weight molecular weight heparins compared to unfractionated heparin will benefit patients with uncomplicated proximal DVT. Using low weight molecular weight heparins would not require regular monitoring, one injection in a day can be used to prevent DVT for patients who undergone TKR. This would be one of the cost-effective mechanism the hospital could adopt (Lane, 2010).
When it comes to safety, the hospital management needs to adopt the most effective patient safety interventions by using anticoagulant drugs to prevent venous thromboembolism in patients at risk. Because important decisions about pharmacologic interventions are made with knowledge based on their economic consequences, it is important for the hospital to consider the economic advantages of some of the anticoagulant drugs like low weight molecular weight heparins (Langer and Amin, 2012). Considering the economic advantages of low weight molecular weight heparins and fondaparinux, a review of 39 articles proves that low-molecular-weight heparins and fondaparinux are the best options and economically attractive strategy for venous thromboembolism prevention among the majority of medical and surgical patients (Argunet al., 2013). Even though fondaparinux is often associated with increased bleeding occurrences, low-molecular-weight heparins remain the most economically attractive drugs for venous thromboembolism prevention, especially for hospitalized patients.
Proposed Solution in Managing Deep Venous Thrombosis (DVT)
The proposed solution is to use Low-molecular-weight Heparin also known as Nadroparin. Most experts try to analyze the impact of Deep Vein Thrombosis (DVT) after Total Knee Replacement proposing several mechanical prophylaxis in preventing deep-vein thrombosis because an optimal regime of antithrombotic prophylaxis with no risk of hemorrhagic complications has not yet been established (Bounameaux, 2011). More adult patients prefer total knee replacements; the number of patients seeking knee replacements is expected to grow as most patients would prefer modern total knee arthroplasty. Introducing total condylar prosthesis would be an ideal way of knee replacement. Modern total knee arthroplasty includes replacing the old surface of the knee. This is further covered with metal and polyethylene prosthetic components. If the procedure is done accurately for properly selected patients, the results can bring significant pain relief and improve patients function and quality of life. However, medical experts warn that before using these modern methods, it is important for the hospital to involve patients on a serious medical discussion in relation to the risks, benefits, and even other alternatives. These risks of using modern methods include preoperative, operative, and postoperative effects. Conversely, medical experts still recommend the use of LMWH prophylaxis to reduce the rate of venous thromboembolism (VTE) and PE when using these modern methods (Martin, Thornhill &Katz, 2013).
There are cases where after total hip or knee replacement surgery, patients still are at a higher risk of developing deep-vein thrombosis despite using prophylaxis with low-molecular-weight heparin. Unfractionated heparin has been proposed for preventing postoperative thromboembolism and for treating established deep vein thrombosis and pulmonary embolism. This is because i...