Content area
Full Text
A thorough review of cur- rent and classic literature was completed to distinguish the influence of bedrest or ambulation on patient treat- ment outcomes with con- firmed deep vein thrombosis.
Deep vein thrombosis (DVT) is a "major public health problem" (Galson, 2008, p.9) impacting the entire nation and affecting as many as 350,000 people yearly. Recognizing DVT and pulmonary embolism (PE) as a possible contributing factor in over 100,000 deaths, the Surgeon General issued a Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism in 2008. In many cases, undiagnosed DVT may result in fatal PE (Baglin, 2009). Before controlled anticoagulation was a viable option, many health care providers were taught thrombus masses may become dislodged with activity, and mandatory bedrest was the most reasonable treatment of choice for DVT (Aschwanden et al., 2001; Trujillo- Santos et al., 2005). The combination of the diagnosis of DVT and the strict bedrest order caused patient anxiety and fearfulness, and could be demoralizing due to lack of control and loss of independence. The current option to ambulate after confirmed DVT is confirmed may improve patient satisfaction and decrease the patient's recovery time.
The Medical-Surgical Research Utilization Team (MSRUT) at West Virginia University Hospitals (Morgantown, WV) recognized discrepancies among three disciplines in regard to expected treatment orders in patients with confirmed DVT. This initiated a research utilization project to improve patient outcomes by using best practice according to the literature. Synthesis of the literature will drive a practice change in the care of the patient with DVT at this hospital system.
Introduction
The MSRUT members informally surveyed attending physicians, nurses, and physical therapists on three acute surgical units and one subacute care unit. The survey, which was voluntary and nonscientific, asked each provider a specific question (see Table 1).
Nurses expected an order for bedrest and no sequential compression devices (SCDs); physical therapists expected an order for ambulation, if anticoagulated; and physicians recommended ambulation with additional treatments. Those additional treatments included use of SCDs, anticoagulants, or antiplatelet agents. In contrast to nurses, no physicians or physical therapists recommended strict bedrest. The purpose of this review was to determine the efficacy of bedrest in patients diagnosed with DVT.
Review of Literature
A comprehensive search of the literature...