Nurse-led intervention in deep vein thrombosis development following major orthopedic surgery: A quality improvement...

Deep vein thrombosis (DVT) accounts for most of thrombotic events following major orthopedic surgery. The development of DVTs increases medical costs and affects patient outcomes. Evidence suggests that ankle exercise helps to prevent DVTs after orthopedic surgery.

A quality improvement project employing a quasi-experimental study design was conducted at a tertiary specialized hospitalized setting from August 2023 to January 2024. The project implemented a nurse-led evidence-based ankle exercise practice among adult patients undergoing major orthopedic surgery, aimed at evaluating the implementation process outcomes including staff adherence and agreement to the practice, and assessing patient outcome for the impact of the practice in DVT development. Nurse adherence was assessed by chart review, nurse agreement was collected using a validated Chinese version Normalization Measure Development (NoMAD) survey tool, DVT rate obtained as patient outcome was calculated via hospital information system.

Nurse adherence to the evidence-based ankle exercise practice was 83 %. There were varying levels of agreement based on specific aspects of the NoMAD survey tool (100 % coherence insights; 85 % cognitive participation; 83.8 % reflexive monitoring; 68.6 % collective action). The incidence of DVT declined after the intervention introduction from 6.5 % to 4.8 % (p = .681).

Through this nurse-led evidence-based ankle exercise practice, we identified nurses adhered to the working process, and the DVT rate decreased in major orthopedic surgery. Further, a more rigorous study with a larger sample size might be needed to confirm the effectiveness of the ankle exercise in preventing DVT on major orthopedic surgery.