Venous Thromboembolism (VTE) prophylaxis following hip and knee replacement surgery: evidence based proposal for changing practice

Mossop, Rebecca (2017) Venous Thromboembolism (VTE) prophylaxis following hip and knee replacement surgery: evidence based proposal for changing practice. Masters thesis, University of Cumbria. Item availability may be restricted.

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Abstract

This dissertation forms a proposed change to the author’s clinical practice. As an Advanced Nurse Practitioner, the author is encouraged to review current literature to ensure the clinical practice they provide is in line with current guidance. From this, it became apparent that the venous thromboembolism prophylaxis treatment given to patients’ receiving total hip and knee replacement surgery, within the author’s clinical area was not in reflection of NICE guidance. Within current practice patients receive enoxaparin, 40mg, sub-cut, once daily whilst in hospital and are then switched to rivaroxaban, 10mg, orally, once daily for fourteen days following total knee replacement and thirty-five days following total hip replacement on discharge from hospital. Dual therapy of anti-coagulant treatments is not endorsed in the NICE (CG 92, 2010) guidance, instead, either enoxaparin or rivaroxaban should be administered from day one post-operative until day fourteen following total knee replacement and thirty-five following total hip replacement. A thorough review of the literature relating to this subject area was conducted. The NICE (CG, 2010) guideline was analysed to evaluate the research used to compile this guidance. Four other journal articles were included as they were high quality, relevant and written following the publication of NICE guidance, this was to ensure there were no new findings to support the treatment currently offered in clinical practice. Critical analysis of various change models and problem solving tools allowed the author to choose those that are relevant and feasible within their clinical area. The change and evaluation chapter was structured using Kotter’s (1996) change model, by following each step, this allowed the author to propose an effective, sustainable change to practice. Kurt Lewin’s (1953, cited in Gottwald and Lansdown, 2014) ‘force field analysis’ tool highlighted the driving forces and potential barriers towards this change, the use of problem solving tools throughout this dissertation identify how these can be overcome or prevented. It is proposed quantitative data for this research will be collected through a telephone survey, compiling data to establish if rivaroxaban is more effective towards the prevention of VTE post-operative and to establish the prevalence of major bleeding events compared with enoxaparin. If the data does not show a great difference between the two treatments, further research into the cost-effectiveness of both treatments would be performed to establish which individual treatment should be used in the author’s clinical practice.

Item Type: Thesis (Masters)
Departments: Faculty of Health and Science > Nursing, Health and Professional Practice
Additional Information: Dissertation submitted in part fulfilment for the MSc Advance Practice (Clinical).
Depositing User: Anna Lupton
Date Deposited: 13 Oct 2017 10:16
Last Modified: 14 Oct 2017 16:30
URI: http://insight.cumbria.ac.uk/id/eprint/3299

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