Evidences For The Physical Prevention And Management Of Perioperative Venous Thromboembolism In Patients Undergoing Total Keen And Hip Arthroplasty

Objective:1.Summarize the evidences related to the physical prevention and management of venous thromboembolism(VTE)in patients with total knee arthroplasty(TKA)and total hip arthroplasty(THA),and evaluate,summarize and analyze,and construct review indicators based on the best evidences.2.Carry out clinical review based on review indicators,analyze and compare the gap between clinical practice and evidences.3.According to the clinical review results,analyze the obstacle factors and improvement measures at the system level,individual level and patient level in the process of evidence application,and construct strategies for perioperative VTE physical prevention and management of TKA and THA patients.4.Patient level: reduce the incidence of VTE and bleeding risk in patients with TKA and THA during the perioperative period,improve patient satisfaction,and standardize patient VTE physical prevention behavior;practitioner level: improve nurses’ ability to prevent and manage VTE physical;system level : Standardize the nursing process of perioperative VTE physical prevention and management of patients with TKA and THA.Methods:1.Based on the evidence "6S" pyramid model,retrieve Up To Date,BMJ,JBI,AAOS,NICE,ASH,SIGN,The Cochrane Library,Pub Med,CINAHL,EMBASE,Web of Science,Sino Med,and CNKI from top to bottom.Clinical decision-making,guidelines,expert consensus,best practices,and evidence summary in databases.The retrieval time was from January 1,2010 to August 17,2020.Four researchers reviewed the included literature Independent evaluation and screening are carried out separately,and the documents that meet the inclusion requirements are summarized and the review indicators are constructed.2.Using participatory observation methods,we selected orthopedic surgeons,nurses,and patients undergoing total knee and hip replacement surgery in our hospital from April30,2020 to August 31,2020 as the research objects,and performed the investigation based on the research team’s self-developed checklist.Situation review.3.Using a purposeful sampling method,select orthopedic surgeons,nurses and patients undergoing total knee hip replacement surgery in our hospital from September 1,2020 to September 30,2020 as the research objects,and conduct structural focus based on the results of the baseline review Conduct interviews,analyze obstacles,and formulate improvement measures.4.Using the before and after history comparison,compare the changes at the patient level,practitioner level,and system level in the baseline review group,the group after the evidence is applied.Results:1.Part one: A total of 17 documents were included and 29 best evidences were summarized,including 3 time periods before,during and after total knee hip replacement surgery,and 4 dimensions of assessment,graded prevention,physical prevention,and health education.2.Part two: Develop 17 review indicators based on 29 best evidences.There are 5review indicators for clinical compliance rated≥80%,and 12 review indicators for clinical compliance rate<80%.3.Part three: The main obstacles are the imperfect VTE risk assessment and management process at the system level;the personal level of VTE prevention and management knowledge of medical staff is not high and targeted intervention strategies are formulated.4.Part four: Patient level: The incidence of VTE in patients with TKA and THA decreased from 5.71% to 0 during the perioperative period.The score of VTE physical prevention knowledge of patients increased significantly(P<0.05),and the length of hospital stay decreased significantly(P<0.05),The patient satisfaction rate increased from72.42% to 96.86%.Practitioner level: The scores of knowledge,belief and behavior of nurses in VTE physical prevention and management were significantly improved(P<0.05).System level: Standardize the nursing process of perioperative VTE prevention and management for patients with TKA and THA,and introduce a patient bleeding risk assessment scale.Conclusion:Based on the model of continuous quality improvement of evidence,the evidence-based practice of perioperative VTE prevention and management of patients undergoing total knee hip replacement surgery has effectively reduced the incidence of perioperative VTE and bleeding risk in patients with TKA and THA.Standardize patients’ VTE physical prevention behaviors and improve patients’ knowledge level of VTE prevention.Improve nurses’ knowledge,belief and practice level of VTE prevention and management;standardize the nursing process of perioperative VTE prevention and management of TKA and THA patients,which will not only provide evidence for physical prevention of perioperative venous thrombosis in patients undergoing total knee and hip replacement surgery in other hospitals in the future Transformation provides the basis and can further promote clinical practice changes and continuous quality improvement.