NUR 302 Nursing : About the Clinical Practice

Answer:

Appraisal of clinical practice guideline article

The article by (Qaseem et al., 2011) gives insight into the clinical practice guideline for Venous Thromboembolism (VTE) Prophylaxis in hospitalized patient. The article is high quality evidence as it covers all important decisions that a nurse need to meet before conducting venous thromboembolism prophylaxis. For example, the article mentioned the need to assess risk for thromboembolism and bleeding before deciding on Venous Thromboembolism (VTE) prophylaxis. Secondly, the decision about heparin prophylaxis was also strengthened by giving evidence for risk factors of VTE and bleeding. This is in consistent with the research by (Kahn et al, 2012) which also mentions considering risk factor of bleed before the procedure.

The main risk for patient who needs VTE prophylaxis includes risk for developing VTE and the guideline presented adequate clinical steps to minimize the risk by comparing with heparin and no heparin therapy in medical patients.

There are many uncertainties in the recommendation of assessment of risk for bleeding and thromboembolism prior to VTE prophylaxis, use of mechanical prophylaxis with stockings and choice of drugs in hospitalized patients. This is because the article does not gives strong evidence regarding the effectiveness of prophylaxis with heparin in high risk individuals such as patients with stroke. However, assessment of risk factors for bleeding like age, cancer, diabetes, peptic ulcer and other relevant conditions was supported by moderate evidence. The positive outcome for patient is not guaranteed because article does not support all the measures.

The recommendation of clinical performance measures is clinically significant because this consideration would support a nurse to assess risk in individuals with the manifestation of different risk for VTE. However, this recommendation cannot be targeted for all audiences and nurse needs to consult clinicians for those individuals for whom risk would exceed the benefit.

References

Kahn, S. R., Lim, W., Dunn, A. S., Cushman, M., Dentali, F., Akl, E. A., ... & Schulman, S. (2012). Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 141(2_suppl), e195S-e226S.

Qaseem, A., Chou, R., Humphrey, L. L., Starkey, M., & Shekelle, P. (2011). Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 155(9), 625-632.