Educational outreach visits to improve nurses’ use of mechanical venous thromboembolism prevention in hospitalized medical patients

Abstract

Venous thromboembolism is a significant cause of morbidity and mortality in hospitalised medical patients. Evidence-based guidelines exist for preventing VTE but unfortunately these guidelines are not always adhered to by clinicians. The aim of this study was to evaluate the acceptability, utility and clinical impact of an Educational Outreach Visit (EOV) on nurses' provision of mechanical prophylaxis to hospitalised medical patients using a prospective uncontrolled before-and-after design. Nurses received a one-to-one educational session on mechanical VTE prevention by a trained nurse facilitator. The EOV intervention was designed by a multidisciplinary group of healthcare professionals using social marketing theory.Eighty five of the 120 eligible nurses (71%) received the EOV. The median length of each visit was 11.5 minutes (interquartile range 10-15) and the median time spent arranging and conducting each visit was 63 minutes (interquartile range 49-85). Eighty four (98.8%) of the 85 participants gave a verbal commitment to trial the new evidence-based mechanical VTE prevention practices. However, there were no measurable improvements in the proportion of patients risk assessed (-1.7% improvement, 95% CI -7.0 to 10.3, p=0.68) or provided appropriate mechanical prophylaxis (-0.3% improvement, 95% CI -13.4 to 14, p=0.96).Researchers conclude that EOV should not be used to improve nurses use of mechanical VTE prevention as it has no measurable impact on clinical practice and is resource intensive requiring four and a half minutes of preparation for every minute spent face-to-face with participants. Further research into the specific mechanism of action is required to explain the variability in clinical effect seen with this intervention.

A systematic review of the outcomes of educational interventions relevant to nurses with simultaneous strategies for guideline implementation

“…), venous thromboembolism prevention (Duff et al . ), insulin infusion and glycaemic control in cardiac surgery (Hargraves ), and cervical cancer screening in adolescents (Choma & McKeever ). The remaining four studies were based on guidelines developed locally by the researchers and colleagues for: pain assessment and management (Salinas & Abdolrasulnia ) breastfeeding (Davis et al .…”

“…Two papers reported the use of facilitators and clinical rounding in the units during the educational interventions, with the focus on giving feedback about performance (Duff et al . , Hargraves ). In the study by Varaei et al .…”

“…Duff et al . () concluded that educational outreach visits should not be used because they were resource‐intensive and had no measurable impact on venous thromboembolism prevention in clinical practice.…”

“…, Duff et al . ). The studies mainly took place in the USA, which must be taken into account when applying the results to different health care settings.…”

Clinical nurses’ knowledge and practice of venous thromboembolism risk assessment and prevention in South Korea: a cross‐sectional survey

“…Diverse educational methods were previously used in clinical settings to improve the quality of VTE prevention, such as a mandatory interactive web-based VTE training (Wolpin et al 2011) or educational outreach visits by VTE experts to train in-house VTE champion nurses (Duff et al 2013). Although none of these education methods resulted in a clinical reduction in the incidence of VTE in hospitals, focused education for RNs and continual clinical audits on the use of VTE prophylaxis measures should be performed to improve the quality of VTE prevention and prophylaxis for hospitalised patients.…”