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Background

Although hospital-acquired venous thromboembolism (VTE) is largely preventable with risk-appropriate prophylaxis, VTE continues to be an important cause of morbidity and mortality. Numerous interventions aimed at improving prescription, including computerized decision support, have been implemented, resulting in improved ordering of VTE prophylaxis. However, ordering prophylaxis does not ensure patients—even hospitalized patients—receive every dose. A surprisingly high proportion (12%-16%) of doses is not administered, largely due to patient refusal accounting for more than half of missed doses. Nonadministration of VTE prophylaxis is associated with VTE events. To address this problem, we hypothesize that nurse-specific and patient-centered education can reduce rates of nonadministered pharmacologic prophylaxis.

Objectives

We sought to engage patients and stakeholders to create educational materials for patients and nurses that could be studied to examine the effect on missed doses of VTE prophylaxis.

Methods

We undertook a multitier, multidisciplinary intervention at the Johns Hopkins Hospital (JHH) from March 2014 to December 2015 to improve administration of VTE pharmacologic prophylaxis. The first stage involved the development of a patient-centered VTE education bundle with input from nationally representative patient stakeholders and a local patient advocacy group using a modified Delphi method. In the second stage, we initiated a nurse education intervention, which was a cluster randomized clinical trial of 2 web-based modules (dynamic scenario-based education and linear static education) to …