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Clinical Informationist at EUH Branch Library

What are the recommendations for use of graduated compression stockings in hospitalized patients?

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For medical patients:

DVT prophylaxis for medical patients. In: DynaMed Plus. References two practice guidelines that address use of stockings in hospitalized medical patients.

American College of Chest Physicians (ACCP) suggests usage of the stockings or intermittent pneumatic compression if risk factors for VTE and high risk for bleeding are present. Chest. 2012; 141 (2 Supp). Section 2.7 reviews evidence for use of compression stockings or other mechanical devices in hospitalized medical patients.

American College of Physicians (ACP) does not recommend use of graduated compression stockings for thromboprophylaxis. Ann Intern Med 2011 Nov 1;1559):625-632.
The section “Comparative Effectiveness of Mechanical Devices versus No Mechanical Devices” (p. 627) summarizes evidence and references studies.

There are additional recommendations for compression stockings in medical patients in DynaMed Plus:See prevention section of entry for Deep Vein Thrombosis.

Documents from the Joanna Briggs Institute EBP Database reviewed evidence and provided recommendations for use of compression stockings in hospitalized patients but did not specifically discuss frequency of changing stockings or other aspects of their use other than using knee-length stockings in surgical patients who are for some reason unable to tolerate the thigh-length stockings.  See these documents for summaries and references to the evidence.

To retrieve the following documents use the Joanna Briggs Institute EBP Database. Copy and paste the document title in the search box.

  • Search for “Deep vein thrombosis prophylaxis” to find latest evidence summaries.
  • Search for “Graduated compression stockings clinician information” to find latest evidence summaries.

For surgical patients:

See guidelines section in entry forDeep vein thrombosis (DVT) prophylaxis for surgical patients. In: DynaMed Plus. To view summary of specific evidence, view section for a surgical specialty (e.g., general and abdominal surgery, neurosurgery, etc.)

To retrieve the following documents use the Joanna Briggs Institute EBP Database. Copy and paste the document title in the search box.

  • Search for “Hip fracture management older people” to find the latest recommended practices.
  • Search for “Graduated compression stockings for the prevention of post-operative venous thromboembolism” to view a 2008 technical report.

Reviewed and updated 4/8/2014 ldt

Does hourly rounding reduce the risk of accidental falls in a cardiovascular surgical unit?

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A CINAHL search for (rounds OR rounding) AND falls AND (cardiac OR coronary OR cardiovascular) did not retrieve any results.

A search for (rounds OR rounding) AND falls AND (surgical OR surgery OR postoperative) retrieved 13 references, including these studies in medical-surgical units:

Effects of rounding on patient satisfaction and patient safety on a medical-surgical unit. Woodward JL; Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2009 Jul-Aug; 23 (4): 200-6.

Hourly Rounding: A Replication Study. Olrich, Todd; Kalman, Melanie; Nigolian, Cindy; MEDSURG Nursing, 2012 Jan-Feb; 21 (1): 23-36.

A search in PubMed found these two additional articles.

Krepper, Rebecca, et al. “Evaluation of a Standardized Hourly Rounding Process (SHaRP).” Journal for healthcare quality 36.2 (2014):62-69.
The first took place in two 32-bed cardiovascular surgery nursing units.

Ciccu Moore, Rita, et al. “Care and comfort rounds: improving standards.” Nursing management 20.9 (2014):18-23.
This study took place in an orthopaedic and surgical rehabilitation ward.

See also Does hourly or intentional rounding reduce the rate of accidental falls in acute care facilities?

See also Are inpatients with cardiac conditions or on diuretic therapy at risk for falls and is there any evidence of interventions to reduce falls in this population?
This blog entry references a couple of papers in the search  results that include patients with cardiac conditions in their populations.  You might be able to extrapolate strategies to your population.

Reviewed and updated 4/8/2014 ldt

Are inpatients with cardiac conditions or on diuretic therapy at risk for falls and is there any evidence of interventions to reduce falls in this population?

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PubMed search for falls AND (inpatients OR hospitalization) AND ((drugs AND adverse effects) OR diuretics OR cardiac OR cardiovascular OR heart)

Risk
Several papers report on risk of falling associated with these conditions.
These look at conditions, including cardiac, associated with falls: Belita (2013), Forrest (2012), de Carle (2001), Tutuarima (1997)
These studies report on association of drugs: Williams (2014), de Groot (2013), Butt (2013), Payne (2010), Shuto (2010),  Tanaka (2008), Gales (1995).

Prevention
Belita (2013) describes a project that focused on cardiac-related falls and injuries. Forrest (2012) addresses prevention of falls in patients on a rehabilitation unit, including those with cardiac admission diagnosis.

Williams, Tamara, Marilyn Szekendi, and StephenThomas. “An analysis of patient falls and fall prevention programs across academic medical centers.” Journal of nursing care quality 29.1 (2014):19-29.

de Groot, Maartje, JP van Campen, MA Moek, et al. “The effects of fall-risk-increasing drugs on postural control: a literature review.” Drugs & aging 30.11 (2013):901-920.

Butt, D A, et al. “The risk of falls on initiation of antihypertensive drugs in the elderly.” Osteoporosis international 24.10 (2013):2649-2657.

Belita, Lydia, P Ford, and H Kirkpatrick. “The development of an assessment and intervention falls guide for older hospitalized adults with cardiac conditions.” European journal of cardiovascular nursing 12.3 (2013):302-309.

Payne, Rupert A, et al. “Association between prescribing of cardiovascular and psychotropic medications and hospital admission for falls or fractures.” Drugs & aging 30.4 (2013):247-254.

Forrest, George, “Falls on an inpatient rehabilitation unit: risk assessment and prevention.” Rehabilitation nursing 37.2 (2012):56-61.

Shuto, Hideki, et al. “Medication use as a risk factor for inpatient falls in an acute care hospital: a case-crossover study.” British journal of clinical pharmacology 69.5 (2010):535-542.

Tanaka, Mamoru, et al. “Relationship between the risk of falling and drugs in an academic hospital.” Yakugaku zasshiŒ 128.9 (2008):1355-1361.

de Carle, A J, and R Kohn. “Risk factors for falling in a psychogeriatric unit.” International journal of geriatric psychiatry 16.8 (2001):762-767.

Tutuarima, J A, et al. “Risk factors for falls of hospitalized stroke patients.” Stroke 28.2 (1997):297-301.

Gales B J, and S M Menard. “Relationship between the administration of selected medications and falls in hospitalized elderly patients.” The annals of pharmacotherapy 29.4 (1995):354-358.

Reviewed and updated 4/7/2014 ldt

What evidence is published on timing and appropriateness of education for patients in the intensive care unit?

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Results below are from a search of PubMed and CINAHL for these concepts:

  • patient education
  • intensive care
  • English language limit
  • time/timing

PubMed:  “Patient Education as Topic”[MAJR] AND “intensive care”[mesh] AND english[lang]

CINAHL:  (MH “Intensive Care Units”) AND (MM “Patient Education+”) AND ( (time OR timing) )   This search focuses on papers that discuss some aspect of timing as it relates to patient education.  Removing the (time OR timing) part of the search will retrieve some additional papers discussing aspects, such as education for transition from ICU to general unit.

The PubMed search results are more general.  The references below discuss general aspects of patient education in the ICU.  Other references in the search results discuss patient education in specific situations, such as with patients on ventilators:

Häggström M, Asplund K, Kristiansen L.  How can nurses facilitate patient’s transitions from intensive care?: a grounded theory of nursing.  Intensive Crit Care Nurs. 2012 Aug;28(4):224-33

Scott A.  Managing anxiety in ICU patients: the role of pre-operative information provision.   Nursing in Critical Care (NURS CRIT CARE), 2004 Mar-Apr; 9 (2): 72-9.

Clark BJ, Moss M. Secondary prevention in the intensive care unit: does intensive care unit admission represent a “teachable moment?”. Crit Care Med. 2011 Jun;39(6):1500-6.

Where can I access the current practice bulletins from the American Congress of Obstetrics and Gynecology?

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Bottom line:  These practice bulletins are published in Obstetrics and Gynecology.  Use this link to display PubMed references for the practice bulletins.

ACOG Practice Bulletins in PubMed

For best results, open the link in your VDT Internet Explorer browser.

To access the full-text options, use the Find It @ Emory button in the full PubMed record for one of the bulletins.

Is there evidence on the use of sequential compression (intermittent pneumatic compression) devices for treatment of active deep vein thrombosis?

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Bottom line:  No evidence identified to support or refute use of sequential compression devices in hospitalized patients with active DVT.

Evidence summary resources (DynaMed, Joanna Briggs) do not mention these devices in relation to treating active deep vein thrombosis (DVT).

A PubMed search for these concepts:    “Venous Thrombosis/therapy”[Mesh] AND “intermittent pneumatic compression devices”[MeSH Terms] AND (“humans”[MeSH Terms] AND English[lang])

Only identified one small (n=24) pilot study in patients with venous thrombosis in the proximal leg who received catheter-directed thrombolytic medication (CDT).  Patients were randomized to either intermittent pneumatic compression device in addtition to CDT or CDT alone.
See:  Ogawa T, et al. J Vasc Surg. 2005 Nov;42(5):940-4. Intermittent pneumatic compression of the foot and calf improves the outcome of catheter-directed thrombolysis using low-dose urokinase in patients with acute proximal venous thrombosis of the leg.

More research would be needed to confirm findings, generalize findings to broader population, etc.

What is the evidence on effect of hyperglycemia on post-surgical complications?

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A search of Joanna Briggs Institute EBP retrieved this evidence summary:
Surgical Site Infection: Post-anesthesia and Post Operative Management. 2015.

It references a systematic review: Blondet JJ, Beilman GJ. Glycemic control and prevention of perioperative infection. Curr Opin Crit Care. 2007;13(4):421-427.
This review references studies documenting effect of perioperative hyperglycemia on post-surgical infection and mortality.

Additional references
PubMed: hyperglycemi* AND (postoperative OR post-operative OR perioperative) AND (complications OR mortality OR morbidity
Retrieves many references.  It is more efficient to begin with the systematic reviews from this search:
hyperglycemi* AND (postoperative OR post-operative OR perioperative) AND (complications OR mortality OR morbidity))systematic[sb]
Some of these reviews will evaluate effect of controling blood glucose in the postoperative period, but they should also address the literature documenting the problem.