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PICO Format: Addressing Health Issues

Three clinical practice problems in my workplace negatively affect the quality of care and patient safety. The first problem is associated with the prevention and management of venous thromboembolism (VTE) in the adult patients admitted to the Medical/Surgical unit and all post-operative patients. The patients demonstrate high rates of non-compliance with VTE prophylaxis. The second issue is the prevention of repeated falls in older adults who underwent coronary artery bypass grafting (CABG) intervention. The third problem is related to pulmonary complications after cardiac surgery. It is unclear whether the use of an incentive spirometer decreases complications and improves patient outcomes. I selected the first clinical practice problem of VTE treatment non-compliance for further analysis. Since non-compliance with thromboprophylaxis is common in my nursing practice and poses significant risks for patient outcomes, I will examine the issue in detail and further develop an answerable question using the PICO format.

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VTE is a serious condition that poses the risk of complications for patients admitted to the Medical/Surgical unit and post-operative patients. The risks of prophylaxis non-compliance include VTEs, pharmacologic vein thrombosis (DVT), and pulmonary embolisms (Wiznia et al., 2019). According to Nana et al. (2020), hospital acquired VTE resulted in 25,000 preventable deaths and significant hospital expenses (p.1). Moreover, Medicare and Medicaid Services do not cover the additional expenses for the treatment of VTE complications caused by patient non-compliance (Wiznia et al., 2019). However, a number of patients in my healthcare facility demonstrate non-compliance with VTE prevention measures. Patient non-compliance might be caused by the lack of knowledge on VTE prophylactic treatment, as 30% of patients reported poor understanding of the procedures and devices used for VTE prevention (Wiznia et al., 2019, p. 30). Therefore, there is a need for patient education on the importance of pharmacologic anticoagulation treatment and instructions that explain how to use mechanical compression devices.

The PICO format helps to focus on the problem of VTE treatment non-compliance using an evidence-based clinical practice approach. In the following table, the PICO mnemonic refers to population, intervention, comparison, and outcome. A patient population might be described based on age, medical condition, or risk (Brown, 2018). For instance, the population may consist of adult patients admitted to the Medical/Surgical unit along with post-operative patients. The intervention section of the table contains information on clinical interventions recommended in a particular clinical case. Patient education on pharmacological VTE treatment and compression devices might be viewed as examples of clinical interventions. The comparison part gives an example of another clinical intervention that is commonly used in the given healthcare facility, such as medication prescription without adequate patient education. Finally, the outcomes section describes important patient outcomes, such as improved VTE treatment compliance and the decrease in preventable deaths.

Nurse Sensitive Indicator Patient non-compliance with VTE prophylactic measures.
PICO Question
Population
P:
Adult patients admitted to the Medical/Surgical unit, including post-operative patients.
Intervention I:
Patient education on the need for pharmacologic anticoagulation treatment and the use of mechanical compression devices.
Comparison C:
Patients have prescribed VTE pharmacologic treatment and compression devices without proper education or instructions.
Outcome O:
Improved VTE prophylaxis compliance and decreased preventable mortality.
Answerable Evidence-Based Practice Question In adult patients admitted to the Medical/Surgical unit, what are the impact of VTE prevention education and instruction on VTE prophylaxis compliance and decreased mortality compared to VTE medication prescription without proper patient education/ instruction?

References

Brown, S. J. (2018). Evidence-based nursing: The research-practice connection (4th ed.). Jones & Bartlett Learning.

Nana, M., Shute, C., Williams, R., Kokwaro, F., Riddick, K., & Lane, H. (2020). Multidisciplinary, patient-centered approach to improving compliance with venous thromboembolism (VTE) prophylaxis in a district general hospital. BMJ Open Quality, 9, 1–7. Web.

Wiznia, D. H., Swami, N., Nguyen, J., Musonza, E., Lynch, C., Gibson, D., & Pelker, R. (2019). Hematology Reports, 11, 30–33. Web.

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