A review of the current prehospital assessment and treatment of Deep Vein Thrombosis (DVT), with a proposed change to paramedic practice by the use of the Wells assessment tool to create a direct clinical pathway for DVTs

Morris, Annmarie (2017) A review of the current prehospital assessment and treatment of Deep Vein Thrombosis (DVT), with a proposed change to paramedic practice by the use of the Wells assessment tool to create a direct clinical pathway for DVTs. Masters thesis, University of Cumbria. Item availability may be restricted.

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Abstract

Patients presenting with a Deep Vein Thrombosis (DVT) is a frequently experienced medical emergency faced by paramedics. Practising paramedics are trained to a variety of different levels from courses completing the outdated Institute of Health and Care Development (IHCD) to more current up to date university diploma/degree programmes. This result in a considerable variable level of clinical skills needed to assist in diagnoses and management of DVTs. Currently, patients suffering from a DVT in the prehospital setting are assessed by paramedics and transported to the nearest Accident and Emergency (A&E) department for treatment, where they can experience long waiting times before treatment is even started. This proposal has explored current paramedic practice and suggested improvements in the assessment, diagnosis, and treatment of patients presenting with DVTs in the prehospital setting. Therefore, recommendations are made to implement a change that will improve patients’ assessment and treatment of DVTs by reducing assessment time and accessing treatment quicker as suggested by the National Institute for Health and Care Excellence (NICE) (2015), national guidelines for management of DVTs. This furthermore, supports the proposal by the introduction of the use of the Modified Wells DVTs assessment tools (see Appendix 9), by paramedics in conjunction with a direct clinical pathway for people presenting with a DVTs to be assessed, treated and managed within the community by local General Practitioner (GPs) as an alternative to currently being admitted and treated in hospitals. Furthermore, identification of a DVT would normally result in the patient being transported to their GP surgery for immediate treatment with Rivaroxaban which would be administered and a D-Dimer blood test taken, therefore resulting in an unnecessary transportation to A&E department. The literature demonstrates that the earlier the patient receives anticoagulant treatment for DVT, the less risk of deterioration of their condition and a reduced risk of developing a Pulmonary Embolism (PE) (Goodacre et al. (2006); NICE 2015). Improvements in education and enhanced paramedic clinical skills will inevitably lead to advancement of clinical standards ranging from improvements in clinical documentation and clinical audit. Importantly, improving clinical care for patients, by the use of the modified Wells score tool (see Appendix 9), may lead to aspirational career framework changes and further embed the paramedic profession in higher education.

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 Practice Developments: Enhancing Paramedic Practice.
Depositing User: Anna Lupton
Date Deposited: 13 Oct 2017 10:42
Last Modified: 14 Oct 2017 14:01
URI: http://insight.cumbria.ac.uk/id/eprint/3301

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