Practitioners’ practice when evaluating venous thromboembolism risk due to lower limb injuries within the emergency setting.

Abstract

Aim: This study aimed to understand patient care by exploring nurse practitioners’ knowledge and current practice regarding Venous Thromboembolism (VTE) risk assessment and treatment of patients with lower limb injuries within the Emergency setting. Background: The primary motivation for this study was fuelled by my interest in advanced nursing practice and the management of patients presenting with injuries to the emergency department (ED). Healthcare prevention is seen as a key element to improving overall health and to try to curtail the continuously rising healthcare costs. The assessment and prophylaxis of VTE in hospital patients have shown to be both medically and financially beneficial. The action of conducting a VTE risk assessment for patients sustaining a lower leg injury is evidence that an assessment has taken place and therefore justifies the clinical decision for the Registered Advanced Nurse Practitioners (ANP) to prescribe prophylaxis or not for the patient. Method: A parallel results convergent mixed-methods research design was conducted. Quantitative and qualitative data were collected in parallel, analysed independently then merged. An online survey instrument was used to investigate the ANPs' current practice and knowledge concerning VTE risk assessment in lower limb injuries requiring immobilisation. Data was analysed with SPSS and NVivo. Results: The response rate was 85.8% (73/85) from a sample size of 85 ANP in the ED setting. The majority of the respondents 61.7% (n=45) in this study rated their overall knowledge in relation to VTE as poor or fair. 75.3% (n= 55) ANP stated that they are dissatisfied or very dissatisfied with their clinical practice. 86.3% (n= 53) of ANPs were not familiar with internationally recognised risk assessment tools. Conclusion: The need for education and standardisation of VTE guidelines in practice to aid ANPs in their current practice when evaluating VTE risk is paramount. Relevance to clinical practice: Guidelines and risk assessment tools exist in clinical practice but the knowledge surrounding these and the adherence to applying these to patients with lower limb immobilisation is very low.