RESUMO
BACKGROUND: The most preventable causes of death in the hospitalized patient are deep vein thrombosis (DVT) and pulmonary embolism. Despite the long-term (> 15 years) availability of evidence-based consensus guidelines for prevention of venous thromboembolism, thromboprophylaxis remains underused. Improving staff and patient utilization of prophylactic treatment for postoperative patients reduces hospital-acquired venous thromboembolism and improves patient outcomes. Anecdotal evidence and observations of intermittent pneumatic compression (IPC) therapy utilization at the authors' institution suggested that ordered IPC therapy was not consistently in use with postsurgical patients. OBJECTIVES: We sought to increase the use of IPC devices by all staff on our hospital pilot units and to promote sustained use of IPC devices. METHODS: Multiple methodologies were employed to address this issue, including point prevalence audits, root-cause analyses, a nursing survey, and a pilot project on selected surgical units. RESULTS: Statistically significant improvements on the pilot units were achieved by implementing a 3-tier interventional plan. CONCLUSION: Our pilot project demonstrated that nurse education, patient education, and nurse attention to solving systems issues can significantly improve IPC use in surgical patients.
Assuntos
Dispositivos de Compressão Pneumática Intermitente/estatística & dados numéricos , Relações Enfermeiro-Paciente , Educação de Pacientes como Assunto , Embolia Pulmonar/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/administração & dosagem , Terapia Combinada , Feminino , Humanos , Extremidade Inferior , Masculino , Projetos Piloto , Padrões de Prática em Enfermagem , Estudos Prospectivos , Embolia Pulmonar/enfermagem , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/enfermagemRESUMO
Two statistical experimental designs were used to investigate factors involved in 90-day mortality from secondary disease in lethally irradiated mice treated with rat bone marrow. Secondary disease is a graft-versus-host syndrome that has a mortality of about 65-95% in this transplant situation. When the factors--age-of-donor-cells, day-of-cell-injection, dose-of-marrow-cells, sex, and environment--were examined for their main effects and interactions, some combinations of these factors were found to give about 25% 90-day mortality. The experiments indicate that the lowest mortality can be achieved with an injection of 40 million or more cells 1 day after irradiation and an ultraclean environment of unlimited filter-top caging.