STOPDVTs: development and testing of a clinical assessment tool to guide nursing assessment of postoperative patients for DVT.

Abstract

AIMS AND OBJECTIVES:

The purpose of this research was to develop and test a clinical tool to guide nurses' assessment of postoperative patients for Deep Vein Thrombosis (DVT).

BACKGROUND:

Preventing venous thromboembolism (VTE) in hospitalised patients is an international patient safety priority. Despite high-level evidence for optimal VTE prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis (DVT) remains high.

METHODS:

A two stage sequential multi-method design was used. In stage 1 the STOPDVTs tool was developed using a review of the literature and focus groups with local clinical experts. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective sample of 50 postoperative orthopaedic patients.

RESULTS:

Stage 1: The focus group members who were members of the nursing leadership team agreed on eight local and systemic signs and symptoms that should be included in a nursing patient assessment tool for early DVT. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. Systemic signs included in the tool were: increased shortness of breath, increased respiratory and heart rates, and decreased oxygen saturation. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of individual signs and symptoms varied between 44 and 94%. Surgical nurses were less likely than the expert nurse to identify signs indicative of DVT.

CONCLUSION:

Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. The findings reveal a gap in nursing knowledge and skill in assessing for DVT in postoperative orthopaedic patients.