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In Focus: AORN's new recommended practices for preventing DVT
AORN’s new recommended practices for preventing DVT By Margarette Burnette
T
he prevention of deep vein thrombosis (DVT) is important at all levels of a health care organization, but it is a special priority for perioperative registered nurses. Perioperative patients often have elevated risks for DVT because they are not able to move about, they may have tissue trauma and the patient positions for surgery also could put them at increased risk, says Byron Burlingame, MS, RN, CNOR an AORN perioperative nursing specialist.
In order to provide patients with optimal levels of care, AORN is releasing the Recommended Practices (RP) for Prevention of Deep Vein Thrombosis. The RP, which will be released in March, describes nine recommendations for an optimal level of practice. “The new recommended practices will provide guidance for perioperative nurses to better identify and minimize DVT risks,” says Burlingame, the lead author. The RP will replace the AORN Guideline for Prevention of Venous Stasis that was published in 2006, says Burlingame. The new RP contains less background information than the previous guideline and more actionable steps. The first recommendation in the RP is for the development and implementation of an organization-wide protocol for the prevention of DVT, to include care of the perioperative patient. This protocol should include perioperative-specific DVT prevention measures such as patient positioning, compression of tissue caused by retraction and use of a pneumatic tourniquet. According to the RP, the organization-wide protocol also should involve key stakeholders identified by the health care organization, including RNs, physicians, anesthesia professionals and pharmacists. “The recommendations concentrate very heavily on developing a protocol for DVT prevention using a multi-disciplinary team, “says Burlingame. doi: 10.1016/S0001-2092(11)00033-0
© AORN, Inc, 2011
By helping to establish an organization-wide protocol, perioperative nurses can help prevent DVT in a variety of perioperative settings, including in-patient hospitals and ambulatory surgery centers, he says. The new RP also updates references to include recommendations from the American College of Chest Physicians (ACCP), says Burlingame. One ACCP recommendation is the use of a computer decision support system. According to the RP, an organization-wide protocol for the prevention of DVT should include the use of a computergenerated alert identifying the patient at risk for developing a DVT. Sharon Van Wicklin, MSN, RN, CNOR, CRNFA, is now a perioperative nursing specialist for AORN and was a volunteer member of the Recommended Practices Committee who helped create the RP. Van Wicklen says it’s important for perioperative nurses to become familiar with the appropriate interventions and the scenarios that they would use. “DVT prevention is a really high priority, and it’s something that we can really work to prevent just by the simple things that we can do as nurses,” she says. In fact, the second recommendation in the RP is that perioperative RNs should complete a perioperative patient assessment to determine DVT risk factors. “A patient that presents with more risk factors will require more prophylactic measures,” says Van Wicklin. As the population’s health care demands increase, Van Wicklin believes the new RP is timely for all health care professionals. “We need the members of the team to have the most effective protocol they can possibly have,” she says. “Everybody sees things from a different perspective, and we can put it all together for the best results.” February 2011 Vol 93 No 2 • AORN Connections | C5
T
he prevention of deep vein thrombosis (DVT) is important at all levels of a health care organization, but it is a special priority for perioperative registered nurses. Perioperative patients often have elevated risks for DVT because they are not able to move about, they may have tissue trauma and the patient positions for surgery also could put them at increased risk, says Byron Burlingame, MS, RN, CNOR an AORN perioperative nursing specialist.
In order to provide patients with optimal levels of care, AORN is releasing the Recommended Practices (RP) for Prevention of Deep Vein Thrombosis. The RP, which will be released in March, describes nine recommendations for an optimal level of practice. “The new recommended practices will provide guidance for perioperative nurses to better identify and minimize DVT risks,” says Burlingame, the lead author. The RP will replace the AORN Guideline for Prevention of Venous Stasis that was published in 2006, says Burlingame. The new RP contains less background information than the previous guideline and more actionable steps. The first recommendation in the RP is for the development and implementation of an organization-wide protocol for the prevention of DVT, to include care of the perioperative patient. This protocol should include perioperative-specific DVT prevention measures such as patient positioning, compression of tissue caused by retraction and use of a pneumatic tourniquet. According to the RP, the organization-wide protocol also should involve key stakeholders identified by the health care organization, including RNs, physicians, anesthesia professionals and pharmacists. “The recommendations concentrate very heavily on developing a protocol for DVT prevention using a multi-disciplinary team, “says Burlingame. doi: 10.1016/S0001-2092(11)00033-0
© AORN, Inc, 2011
By helping to establish an organization-wide protocol, perioperative nurses can help prevent DVT in a variety of perioperative settings, including in-patient hospitals and ambulatory surgery centers, he says. The new RP also updates references to include recommendations from the American College of Chest Physicians (ACCP), says Burlingame. One ACCP recommendation is the use of a computer decision support system. According to the RP, an organization-wide protocol for the prevention of DVT should include the use of a computergenerated alert identifying the patient at risk for developing a DVT. Sharon Van Wicklin, MSN, RN, CNOR, CRNFA, is now a perioperative nursing specialist for AORN and was a volunteer member of the Recommended Practices Committee who helped create the RP. Van Wicklen says it’s important for perioperative nurses to become familiar with the appropriate interventions and the scenarios that they would use. “DVT prevention is a really high priority, and it’s something that we can really work to prevent just by the simple things that we can do as nurses,” she says. In fact, the second recommendation in the RP is that perioperative RNs should complete a perioperative patient assessment to determine DVT risk factors. “A patient that presents with more risk factors will require more prophylactic measures,” says Van Wicklin. As the population’s health care demands increase, Van Wicklin believes the new RP is timely for all health care professionals. “We need the members of the team to have the most effective protocol they can possibly have,” she says. “Everybody sees things from a different perspective, and we can put it all together for the best results.” February 2011 Vol 93 No 2 • AORN Connections | C5