The effects of an anticoagulation program on patient compliance following total joint replacement
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Patients undergoing major orthopedic surgery have shown the potential for deep vein thrombosis (DVT) ranging from 46% to 60% postoperatively. To avoid this risk, home rehabilitation is recommended, including nursing and/or physical therapy, proper monitoring of international normalized ratios (INRs), and anticoagulant medication compliance. This quality improvement initiative was done to address the gap in care of inadequate tools for the clinicians to properly manage anticoagulant dependent patients as well as the inconsistency of anticoagulation therapy management and care. Applying the five steps of the Iowa model of evidence-based practice, an anticoagulation therapy program was created including an organizational clinician certification. The primary outcome variable involved patients’ INR values; secondary outcomes included patient satisfaction scores, evaluation of the number of rehospitalizations and patient adverse events; monthly rating scores from Medicare’s Home Health Compare; and collaboration of the organization’s root cause analysis team. No significant improvements were observed in the primary outcomes during data collection. However, Press Ganey patient satisfaction ratings related to medication education and disease process teaching showed an improvement. Home Health Compare ratings remained the same. Other quality improvement studies may benefit from the lessons learned, and continued efforts to improve anticoagulation in orthopedic surgery patients are needed.
This work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
Type | DNP Capstone Project |
Acquisition | Self-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Evidence Level | Clinical Practice Guideline(s) |
Research Approach | Translational Research/Evidence-based Practice |
Keywords | Warfarin; International Normalized Ratio; Deep Vein Thrombosis; Orthopedic Surgery Patients; Medication Compliance |
CINAHL Subject(s) | Orthopedic Surgery--Adverse Effects; Orthopedic Surgery; Venous Thrombosis; Venous Thrombosis--Prevention and Control; Arthroplasty, Replacement; Arthroplasty, Replacement--Adverse Effects; Anticoagulants; Patient Compliance; Medication Compliance |
Grantor | Capella University |
Advisor | Jones, Terri; Sheppard, Katherine; Bassey, Mary |
Level | DNP |
Year | 2017 |
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