Year of Publication

2021

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Candice Falls

Committee Member

Dr. Melissa Czarapata

Committee Member

Dr. Devan Costelle

Abstract

Purpose: The purpose of this project was to evaluate the complications and adverse events in left ventricular assist device (LVAD) patients when comparing those using home point of care (POCT) international normalized ratio (INR) testing versus lab testing. Additionally, the time in therapeutic window for both these groups was studied. A cost benefit analysis was performed. All this data was compiled into a provider education evaluated by a pre and post-survey design.

Methods: The project is a single-center study that will occur at the University of Kentucky Chandler Medical Center. It is a cross-sectional, pre/post-test design. Data will be collected retrospectively starting January 2019, and prospectively for three months starting in October 2020. Complications and adverse events were collected through chart review. Time in therapeutic window (TTR) was calculated using the Rosendaal method. INR results were collected from the patient’s medical record. A three question pre and post-test was used to evaluate provider understanding of the topic.

Results: 32 LVAD patients were evaluated for this study. Four providers completed the pre- and post-test with the educational video intervention. While there were more complications in the home point of care group, the results were not statistically significant (p=.15). Further evaluation of TTR yielded a higher TTR for the POCT group, however it was also not statistically significant (p=.17). There was also only a mild increase in provider understanding of the topic.

Conclusion: The findings from this study indicate that more research should be done on the topic. While there were more complications in the POCT group, they were not significant enough to warrant a move to utilizing all lab testing instead of POCT.

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