Johns Hopkins Medicine
Elliott Haut (left) and team Photo courtesy of
Education can improve adherence to venous thromboembolism (VTE) prophylaxis among hospitalized patients, according to researchers.
They assessed data from more than 19,000 hospital stays and found that “real-time” educational interventions directed toward patients and nurses significantly reduced nonadministration of prescribed VTE prophylaxis.
However, this did not translate to a significant reduction in VTE incidence.
Elliott Haut, MD, PhD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland, and his colleagues reported these results in JAMA Network Open.
For this study, the researchers evaluated patients who were prescribed VTE prophylaxis while admitted to Johns Hopkins Hospital between April 1, 2015, and December 31, 2015.
The researchers evaluated patients in 16 hospital units. Four units were targeted for educational intervention, and the remaining 12 units served as controls.
The educational interventions were given only when patients did not receive prescribed VTE prophylaxis. A bedside nurse would document nonadministration, and an alert built into the hospital’s electronic medical record would email and page a health educator.
If the patient had refused prophylaxis, the patient would receive an educational bundle on VTE, which could consist of any or all of the following (patient’s choice):
- A one-on-one discussion with the health educator
- A two-page paper handout (available in eight languages)
- A 10-minute educational video (on a tablet).
If the nonadministration of prophylaxis was not due to patient refusal or contraindication, the health educator would educate the bedside nurse about the importance of giving all prescribed doses of VTE prophylaxis.
The study included 19,652 patient visits during which VTE prophylaxis was prescribed.
Of these, 726 visits were targeted for educational intervention. In 272 visits, the intervention was administered to a nurse alone (n=45) or the nurse and the patient (n=227).
For the remaining 454 visits, the patient was discharged before the intervention (n=123), there was an order to discontinue prophylaxis (n=111), there was a technical error (n=55), the patient (n=43) or health educator (n=41) was off unit, or “other” reasons (n=81).
Results
The proportion of nonadministered doses of VTE prophylaxis declined significantly in the hospital units targeted with educational intervention—from 9.1% pre-intervention to 5.6% post-intervention (odds ratio [OR]=0.57, P<0.001).
However, there was no significant change in the control units—13.6% and 13.3%, respectively (OR=0.98, P=0.62).
The proportion of nonadministered doses for reasons other than patient refusal decreased significantly in the intervention units—from 2.3% to 1.7% (OR, 0.74, P=0.01)—but not in control units—from 3.4% to 3.3% (OR=0.98, P=0.69).
The proportion of nonadministered doses due to patient refusal decreased significantly in the intervention units—from 5.9% to 3.4% (OR=0.53, P<0.001)—but not in control units—from 8.7% to 8.5% (OR=0.98, P=0.71).
“Our study demonstrates that educating patients quickly, as soon as we learn about a missed dose, is not only possible to implement at a large hospital but is effective in ensuring that patients take the drugs that can save their lives,” Dr. Haut said.
“The educational bundles we created are effective and optimize busy clinicians’ already packed schedules,” added study author Brandyn Lau, of the Johns Hopkins University School of Medicine.
“At the end of the day, we’re here to deliver high quality care and keep patients safe, and this is one method of achieving that mission.”
However, the improved adherence to VTE prophylaxis did not translate to a significant reduction in VTE in this study.
The incidence of VTE decreased from 0.30% to 0.18% (OR=0.60) in intervention units and from 0.24% to 0.20% in control units (OR=0.81).
For all patients, the incidence of VTE was 0.26% pre-intervention and 0.19% post-intervention (P=0.46).
This research was supported by a contract from the Patient-Centered Outcomes Research Institute. The study authors reported support from various government agencies and private organizations.