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Patient education increases use of venous thromboembolism prophylaxis
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A real-time, targeted educational intervention for hospitalized patients led to fewer missed doses of venous thromboembolism prophylaxis, according to findings published in JAMA Network Open.
VTE is a leading cause of preventable death among hospital patients, posing an immense economic burden, according to study background.
“Years ago, we started trying to get prescribing of VTE prophylaxis right, and we developed a series of support tools that increased appropriate prescribing to risk-assessed patients,” Brandyn D. Lau, MPH, CPH, assistant professor of radiology and radiological science and health sciences informatics in the Russell H. Morgan department of radiology and radiological science at Johns Hopkins School of Medicine, told HemOnc Today. “We assumed that improved prescription would result in improved prevention practices but, looking at administrative practices, we found that about 12% of prescribed doses of prophylactics aren’t being administered to patients. The driving reason for this is patient refusal.”
In the controlled, preintervention-postintervention comparison study, Lau and colleagues evaluated 19,652 visits by adults (51.7% men; mean age 55.6 years) at Johns Hopkins Hospital during which at least one dose of VTE prophylaxis was prescribed. The sample included 7,879 patient visits in the preintervention interval and 11,773 patient visits in the postintervention interval.
Four hospital units received the intervention (5,333 patient visits), whereas 12 units served as controls (14,319 patient visits).
The intervention was triggered by a real-time alert through the hospital’s electronic medical record system, which paged and emailed a health educator when a prescribed dose of pharmacologic VTE prophylaxis was not given, as documented by the bedside nurse.
The health educator spoke with the bedside nurse to determine the reason for nonadministration. If the patient had refused the prophylaxis, the health educator visited the patient and delivered the patient education bundle. The bundle included one or more of the following: a discussion with a health educator, a two-page printed handout and a 10-minute patient educational video on a handheld tablet.
If nonadministration was linked to a prescriber issue, such as a contraindication, the health educator contacted the prescriber to resolve the problem.
The study’s primary outcome was conditional odds of nonadministration of doses of VTE prophylaxis before and after intervention among control vs. intervention units. Secondary outcomes included reasons for nonadministration and VTE event rates.
Among the intervention units, the conditional odds of prophylaxis nonadministration decreased significantly from the preintervention period (9.1%; 95% CI, 5.2-16.2) to the postintervention period (5.6%; 95% CI, 3.1-9.9; OR = 0.57; 95% CI, 0.48-0.67). There was no change among the control units (13.6%; 95% CI, 9.8-18.7 vs. 13.3%; 95% CI, 9.6-18.5; OR = 0.98; 95% CI, 0.91-1.07; P < .001 for interaction).
The most common reason for prophylaxis nonadministration was patient refusal, the conditional odds of which decreased from 5.9% (95% CI, 2.6-13.6) to 3.4% (95% CI, 1.5-7.8) among the intervention units (OR = 0.53; 95% CI, 0.43-0.65). There was no change among the control units (8.7% vs. 8.5%; OR = 0.98; 95% CI, 0.89-1.08; P < .001 for interaction).
The intervention units also showed a decrease in the conditional odds of nonadministration due to reasons other than patient refusal, from 2.3% (95% CI, 1.5-3.4) to 1.7% (95% CI, 1.1-2.6; OR = 0.74; 95% CI, 0.58-0.94). There was no change in the control group (3.4% vs. 3.3%; OR = 0.98; 95% CI, 0.87-1.1; P = .04 for interaction).
Researchers observed no statistical differences in the proportion of VTE events occurring among patients on intervention vs. control units (0.3% vs. 0.18%; OR = 0.6; 95% CI, 0.16-2.23).
“We saw a significant reduction in missed doses, both missed doses overall and specifically refused missed doses,” Lau told HemOnc Today. “It’s a very effective learning tool for both patients and for bedside nurses. It gave us an opportunity to engage with bedside nurses to educate patients.” – by Jennifer Byrne
For more information:
Brandyn D. Lau, MPH, can be reached at Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 North Wolfe St., Radiology 127, Baltimore, MD 21287; email: blau2@jhmi.edu.
Disclosures : Lau reports no relevant disclosures. Please see the study for all other authors’ relevant financial disclosures.
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