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D.D. Bayquen1, E. Ayoub1, A. Thrush1
1Cleveland Clinic Abu Dhabi, Inpatient Rehabilitation Department, Abu Dhabi, United Arab Emirates
Background: It has been identified that there is lack of consistency and standardization with diagnosis, therapeutic approach, management and appropriate decision-making when PTs are treating patients with LE DVT. This imposes safety risks such as risk of pulmonary embolism, or premature or delayed mobility interventions.
Purpose: This project aims to standardize PT management of patients diagnosed with LE DVT. This includes screening, prevention of risk and occurrence, prescription of safe mobility and physical activity, and patient education.
Methods: Authors completed a comprehensive literature review and identified a clinical practice guideline (CPG) from the American Physical Therapy Association. The guideline was critiqued using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool, which revealed a high level of quality, and led to the decision to implement its recommendations into practice. Algorithms from the CPG were modified according to the organization’s commonly used medications and medical practices, and reviewed by stakeholders from pharmacology and vascular teams. This information was reviewed with the full inpatient team and resources were provided in a central electronic location for ease of reference. Impact of knowledge and practice change was measured through a pre- and post-survey.
Results: The application of CPG recommendations has standardized physical therapist assessments, evaluations of risk profile, and decisions on mobility in the setting of varied medical and pharmacological management. The Well’s Criteria for DVT likelihood has been integrated into the electronic medical record. Knowledge and confidence of PTs regarding screening and management of patient with VTE significant improved. Average performance on the pre- and post-surveys increased from 48% correct responses to 97% correct responses. Before the intervention, 0% of PTs felt confident articulating their role in screening and management of patients with DVT, and after the intervention 57% felt confident. Before the intervention, 0% of PTs had a good level of familiarity with the recommendations of the CPG, and after the intervention 43% did. PTs more consistently recognized the role of the Well’s Criteria in screening for DVT, and were less likely to rely on tests which are not recommended such as Homan’s sign.
Conclusion(s): PTs play a significant role in screening and managing patients who are at high risk for LE DVT, however, until recently there has not been a summary of best evidence to standardize the role and recommendations for PTs. The CPG referenced here has provided the framework with which our department has educated the team and standardized expectations. These efforts are important to ensure that patients are appropriately referred for investigations when at risk of DVT, and to ensure that mobility and PT interventions commence only when safe based on medical and pharmacologic management of an acute LE DVT. This will prevent unsafe practiced that may cause more harm particularly with reference to pulmonary embolism.
Implications: Physical therapists can improve the standards of care, advocate for our professional role, and improve safety and effectiveness of our interventions by implementing recommendations from clinical practice guidelines. Our project demonstrates the outcomes that can be achieved when this is accomplished.
Funding, acknowledgements: There are no funding acknowledgements for this abstract
Keywords: Deep Venous Thrombosis, Mobility, Venous Thromboembolism
Topic: Cardiorespiratory
Did this work require ethics approval? No
Institution: Cleveland Clinic Abu Dhabi
Committee: Research and Ethics Committee
Reason: This project describes the implementation of evidence in order to improve patient outcomes and does not address a research question.
All authors, affiliations and abstracts have been published as submitted.
