James Harrington

Article annotation #1

Mehta, K. V. (2010). Mechanical thromboprophylaxis for patients undergoing hip fracture surgery. Journal of Orthopaedic Surgery, 18, 287-289.

Dr Kinjal V. Mehta is a physician in the Department of Orthopaedic Surgery at Changi General Hospital in Singapore, China. This article outlines a study performed from July 2007 to June 2008 that explored the relevance of mechanical prophylaxis of deep vein thrombosis (DVT) in patients undergoing hip fracture surgery and its content is directed towards physicians and clinical staff. The sample group was relatively small, consisting of only 123 men and 311 women with a mean age of 76 years, but was representative of the norms for this type of fracture across all populations which makes the information relevant. The results of this study were compared to those of a similar study performed at the same facility 6 years prior. These comparisons indicated that the use of mechanical prophylaxis of DVT during hospitalization reduced the incidence of DVT by 69%. From the results of this study the author concluded that routine use of mechanical DVT prophylaxis is recommended in patients undergoing hip fracture surgery.

Annotated article grading rubricCATEGORY 4 3 2 0

Source Source is accurately documented in APA format.

Source is accurately documented, but a few minor errors noted.

Source is accurately documented, but not in APA format.

Source is not accurately documented.

Quality of Information

Information clearly relates to the main topic.

Information clearly relates to the main topic but not organized well.

Information only partially relates to the main topic.

Information has little or nothing to do with the main topic.

Mechanics No grammatical, spelling or punctuation errors.

Almost no grammatical, spelling or punctuation errors

A few grammatical spelling or punctuation errors.

Many grammatical, spelling, or punctuation errors.

Word count About 150 words Under 125 or over 175 words

Under 100 or over 200 words

Under 75 or over 225 words

Initial appraisal All key elements are present:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

Two key elements are present:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

One key element is present:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

Missing key elements:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

Content appraisal All key elements are present:Intended audience, objective reasoning, coverage, and writing style.

Three key elements are present:Intended audience, objective reasoning, coverage, and writing style.

Two key elements are present:Intended audience, objective reasoning, coverage, and writing style.

One key element may be present:Intended audience, objective reasoning, coverage, and writing style.

Article annotation #2

Annamalai, A., Deckard, A. J. (2006). Improving DVT prophylaxis in hospitalized patients: a quality improvement project. Semin Med Pract, 9, 47-53.

Dr’s Annamalai and Deckard are MD physicians practicing in the Division of Internal Medicine at the Southern Illinois School of Medicine. This article has an intended audience of physicians and nurses working in hospital based clinical areas. It outlines several previous studies related to both pharmaceutical and mechanical prophylaxis of deep vein thrombosis (DVT) in order to develop and implement a hospital-wide quality improvement plan. In addition to data gathered from previous studies, information was collected from an additional 169 patient charts. From all data collected it was determined that the use of mechanical DVT prophylaxis alone did not significantly reduce the risk of DVT among hospitalized patient populations. However, a standard points system for determining DVT risk was developed and subsequently initiated that included provisions for the use of mechanical DVT prophylaxis, (which implies that mechanical prophylaxis plays a part in overall treatment), as well as current standard pharmaceutical options. The implementation of a standard DVT prophylaxis order sheet with an assessment tool based on a points system has helped increase awareness of this specific complication seen in both surgical and non-surgical inpatient populations.

Annotated article grading rubricCATEGORY 4 3 2 0

Source Source is accurately documented in APA format.

Source is accurately documented, but a few minor errors noted.

Source is accurately documented, but not in APA format.

Source is not accurately documented.

Quality of Information

Information clearly relates to the main topic.

Information clearly relates to the main topic but not organized well.

Information only partially relates to the main topic.

Information has little or nothing to do with the main topic.

Mechanics No grammatical, spelling or punctuation errors.

Almost no grammatical, spelling or punctuation errors

A few grammatical spelling or punctuation errors.

Many grammatical, spelling, or punctuation errors.

Word count About 150 words Under 125 or over 175 words

Under 100 or over 200 words

Under 75 or over 225 words

Initial appraisal All key elements are present:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

Two key elements are present:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

One key element is present:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

Missing key elements:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

Content appraisal All key elements are present:Intended audience, objective reasoning, coverage, and writing style.

Three key elements are present:Intended audience, objective reasoning, coverage, and writing style.

Two key elements are present:Intended audience, objective reasoning, coverage, and writing style.

One key element may be present:Intended audience, objective reasoning, coverage, and writing style.

Article annotation #3

Limpus, A., Chaboyer, W., McDonald, E., Thalib, L. (2006) Mechanical thromboprophylaxis in critically ill patients: A systematic review and meta-analysis. American Journal of Critical Care, 15, 402-412.

Anthony Limpus, RN, Wendy Chaboyer, RN, PhD, Ellen McDonald, RN, and Lukman Thalib, PhD are clinical specialists in the area of critical care services. In this article they present an extensive comparison of relevant data generated from 5 randomized trials, 13 observational studies, and 3 independent surveys on the topic of mechanical prophylaxis of deep vein thrombosis (DVT) utilizing compression stockings and pneumatic devices. From the detailed explanations it can be assumed that the expected readers of this article are medical professionals. A comprehensive systematic review and detailed meta-analysis failed to produce an overall answer whether the use of mechanical DVT prophylaxis was beneficial to critically ill patients. Because of the wide variety of co-morbidities among study participants there was no specific ruling on the efficacy of mechanical DVT prophylaxis. Therefore, the conclusion presented in this article was that until large randomized controlled trials are conducted revealing statistically significant scientific evidence to the contrary, the use of compression stockings and/or pneumatic devices alone has not been shown to reduce DVT risks in critically ill patients.

Annotated article grading rubricCATEGORY 4 3 2 0

Source Source is accurately documented in APA format.

Source is accurately documented, but a few minor errors noted.

Source is accurately documented, but not in APA format.

Source is not accurately documented.

Quality of Information

Information clearly relates to the main topic.

Information clearly relates to the main topic but not organized well.

Information only partially relates to the main topic.

Information has little or nothing to do with the main topic.

Mechanics No grammatical, spelling or punctuation errors.

Almost no grammatical, spelling or punctuation errors

A few grammatical spelling or punctuation errors.

Many grammatical, spelling, or punctuation errors.

Word count About 150 words Under 125 or over 175 words

Under 100 or over 200 words

Under 75 or over 225 words

Initial appraisal All key elements are present:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

Two key elements are present:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

One key element is present:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

Missing key elements:Author credentials reviewed, article is less than 5 years old, and publication is scholarly.

Content appraisal All key elements are present:Intended audience, objective reasoning, coverage, and writing style.

Three key elements are present:Intended audience, objective reasoning, coverage, and writing style.

Two key elements are present:Intended audience, objective reasoning, coverage, and writing style.

One key element may be present:Intended audience, objective reasoning, coverage, and writing style.

Evidence of Reason

(1) Purpose: Deep vein thrombosis (DVT) is a major complication of many hospitalized patients. Although physicians are responsible for ordering pharmaceutical DVT prophylaxis, at my medical center there is a protocol policy for nurse initiated mechanical DVT prophylaxis using venous foot pumps (VFPs) or sequential compression devices (SCDs); the problem is that many physicians find the nursing policy to be too simplistic in scope. I see a possible solution and a better way to implement a DVT protocol.

(2) Issue: Physicians reviewing the nursing policy for mechanical DVT prophylaxis have commented that the requirements of the protocol are excessive and may actually increase the risk in some patients. One physician statement has been that mechanical DVT prophylaxis impedes movement which could lead to DVT. Further review of associated professional articles failed to confirm documented risks associated with the use of mechanical DVT prophylaxis.

(3) Assumptions: I assume that the physicians who have reviewed this protocol policy have had good reasons for questioning the requirements stated within it. I also assume that physicians have the same degree of concern for their patients and would have no reason for questioning practices which were good for their patients.

(4) Point of view: I have reviewed the current protocol policy and I believe that it needs revision. An example would be a 40 year old female marathon runner who is on birth control pills and is admitted to the hospital following a surgery for an open rotator cuff repair. Under the current policy she meets the requirements for being placed in SCDs or VFPs. My opinion is that initiation of mechanical DVT prophylaxis on this particular patient is unnecessary given the

history presented. Many nursing assessments are based on scales. Why not assign values to various factors which may contribute to DVTs such as age, history, concurrent medications, mobility, etc., and require that the sum of all values equal X before mechanical DVT prophylaxis protocol orders are initiated.

(5) Information: Review of the above listed articles indicates that there is still a definite need for research into this area of medicine. Although a question exists as to the actual benefits of mechanical DVT prophylaxis, the development of a standard point system as well as a DVT assessment order sheet which includes mechanical prophylaxis options has shown to be an important part of raising awareness.

(6) Concepts: Current policy suggests mechanical DVT prophylaxis to be a necessary part of the overall process of preventing this complication in hospitalized patients. The latest information has shown a value to mechanical prophylaxis along with a recommendation to implement these measures suggested by a leading orthopaedic publication. This recommendation, though current, is based on a very small study which may reduce its validity in the eyes in physician providers in non-orthopaedic specialties.

(7) Interpretation: After reviewing current literature I have proven that our nursing policy needs revision. Physicians have not discounted the use of mechanical DVT prophylaxis, but the risk associated with the current policy may be a refusal by physicians to continue authorizing these standing protocol orders. I see the use of a scale to determine SCD or VFP therapy as a viable alternative to our current practices, and a standardized assessment and order sheet as a way to standardize care.

(8) Implications: Whenever protocol orders are proposed they must go through review by many nursing and medical staff members. When assigning specific values to factors such as age, history, etc., there may be a considerable amount of disagreement. I believe that I have now prepared myself to present new alternatives to the current policy. At the very least I will heighten awareness of the potential for DVTs and with the help of several physician champions who have similar feelings I may be able to produce significant changes in our current policy and practices.

EOR sheet rubric

Instructor comments 2 points 0-1 point1.           Purpose Purpose clearly

statedUnclear about their central purpose

2.        Questions at issue or central problem

Clear about the questions they are trying to settle

Express questions vaguely, cannot reformulate questions clearly

3.     Point of view Clear that people have different points of view, especially on

Do not credit alternative reasonable

controversial issues viewpoints4.     Information Assert claims only

when they have sufficient evidence to back it up

Assert claims without considering relevant information

5.   Concepts and ideas

Able to explainbasic implications of key words and phrases they use

Cannot accurately explain basic implications of their key words and phrases

6.      Assumptions

Make assumptions that are justifiable and reasonable given the situation and evidence

Make unjustifiable or unjustified assumptions

7.     Implications and consequences

Clearly and precisely articulate the possible implications and consequences

Unclear about possible consequences they articulate

8.  Inference and interpretation

Make inferences or come to conclusions that are reasonable

Make inferences that do not follow from the evidence or reasons presented

EBPP rubric Possible points

Posted EBPP by deadline /5 5Annotation 1 rubric grade 23/24 23Annotation 2 rubric grade 23/24Annotation 3 rubric grade 23/24Posted week 8 EOR sheet by deadline /3 3EOR sheet rubric (see above) /16 16Completed 2 peer evaluations* on discussion board member EOR sheet by deadline week 8*that posted by the deadline

/2 2

TOTAL 50 49 X 2 = 98