Applying the Iowa Model Revised to VTE Prophylaxis in the ICU Patient

The National Center on Birth Defects and Developmental Disabilities (NCBDDD, 2020) identified venous thromboembolism (VTE) as the leading cause of preventable hospital death in the United States. Intensive care unit (ICU) patients are at an even higher risk for VTE, often due to their clinical presentation and factors associated with ICU admissions , such as prolonged immobility, mechanical ventilation, vasopressor use, and the utilization of central venous catheters (Ejaz et al., 2018). The incidence of VTE is highest among surgical and trauma ICU patients. As a result, this high-risk population typically receives pharmacologic thromboprophylaxis, mechanical therapy, or both. Because of the uncertainty regarding which agents or combinations are best in preventing VTE among critically ill surgical patients, fewer than half of these patients receive the appropriate VTE prophylaxis according to the set guidelines (Beckman et al., 2016). 

It is of the utmost importance to implement the most effective method of preventing VTE by actively engaging in practice change supported by evidence-based practice (EBP) standards. To facilitate an organized approach, the Iowa Model Revised: EBP to Promote Excellence in Healthcare was utilized to guide the implementation of this project.

Iowa Model Revised: EBP to Promote Excellence in Healthcare 

The Iowa Model of EBP was developed to guide and promote successful and sustainable organizational changes. The framework suggests the process of translating research into practice by utilizing a flowchart that involves decision-making points with feedback loops throughout the process (Dang et al., 2019, p. 389). EBP inquiry is initiated by encouraging health professionals to identify questions and current practice standards with an opportunity for improvement. Clinical issues or newly published evidence are triggers that drive clinicians to question their practice. Dang et al. (2019) described this as the first step of the Iowa Model (p. 391). Having identified the trigger, a new addition to the revised model is to formulate the question or state the project’s purpose. If determined that the topic is a priority for the organization, a team is formed to assemble, appraise, and synthesize the body of evidence (Christenbery, 2017). 

The next step in the Iowa Model Revised is to review relevant literature to determine if sufficient evidence is available. If the evidence does support a practice change, a pilot of the change is organized (Christenbery, 2017). The next decision point is to evaluate the pilot testing to allow the team to refine the intervention to ensure sustainable translation. If the change is appropriate for adoption, the final step involves integrating the practice change and monitoring the outcomes, followed by dissemination (Dang et al., 2019, pp. 393-395). 

Model to Change Practice

The Iowa Model Revised was used to facilitate an organized approach for this project. The question of interest in the PICO(T) format asks, “In post-operative ICU adult patients, how does using combined mechanical and pharmacological thromboprophylaxis compared to either modality alone affect the rate of occurrence of VTE during hospitalization?”

The model selected is significantly relevant to the practice problem as it focuses on institutional EBP efforts based on frontline practice issues. The algorithm features a flowchart that guides decision-making and problem-solving steps in which feedback loops guide the change process. For this scholarly project, the updated practice guidelines on VTE prevention linked both problem and knowledge-focused triggers to initiate the EBP process (Dang et al., 2019, p. 391). The indicated problem of increased VTE rates among the postoperative, critically ill patients was deemed a priority of the organization. Another benefit of utilizing the Iowa Model is its requirement for EBP initiates to align to organizational strategic goals (Dang et al., 2019, p. 391). This is essential as any practice change must be supported by the organization to be sustainable. Finally, the project offers an opportunity to change clinical practices related to the EBP to decrease the risk of developing a VTE. 

Conclusion

VTE is a significant patient safety issue across the continuum of care. This scholarly project aimed to evaluate the practice of combining mechanical and pharmacological thromboprophylaxis to determine if it helped reduce the VTE rate compared to a single modality in the postoperative ICU population. The Iowa Model Revised was implemented as a theoretical framework to translate research into practice.