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Real-Time Patient-Centered Education Bundle for VTE Prevention
Study Questions:
Does a real-time, targeted, patient-centered education bundle intervention reduce nonadministration of venous thromboembolism (VTE) prophylaxis in hospitalized patients?
Methods:
The authors performed a nonrandomized preintervention-postintervention comparison of 19,652 patients on 16 units at the Johns Hopkins Hospital between April and December 2015. A patient-centered education bundle was administered on four units if a dose of VTE prophylaxis medication was not administered. The intervention was targeted to the patient, nurse, or prescriber based on the reason for nonadministration. The education bundle consisted of one-on-one, face-to-face education between a patient and health educator; a two-page paper handout; a 10-minute patient education video; and discussion between the nurse, prescriber, and health educator.
Results:
Among the 3,111 patients in the intervention group, 726 (23.3%) experienced at least one nonadministered dose of VTE prophylaxis medication. An intervention was given to 272 (37.5%) patients and/or providers. The health educator spent a median of 2 minutes with the bedside nurse and 10 minutes with the patient. The odds of subsequent VTE prophylaxis nonadministration was 0.88 (95% confidence interval [CI], 0.82-0.95) in the intervention cohort as compared to the control cohort. The proportion of nonadministered doses decreased from 9.1% to 5.6% from the pre- to post-intervention period in the intervention group without any change in the control group (13.6% vs. 13.3%). There was no statistically significant difference in the proportion of VTE events among patients in the intervention and control groups (0.30% vs. 0.18%, odds ratio, 0.60; 95% CI, 0.16-2.23).
Conclusions:
The authors concluded that a targeted, patient-centered education bundle significantly reduced nonadministration of pharmacologic VTE prophylaxis among hospitalized patients.
Perspective:
While many hospitalized patients are at risk for developing VTE, frequent use of injections (e.g., unfractionated or low molecular weight heparin) presents a significant barrier and is a common reason for nonadministration. This study demonstrates that a well-designed educational intervention can reduce medication nonadministration. However, this intervention required a dedicated patient educator, which may be prohibitive for many hospitals. Future studies looking to more broadly disseminate this practice will need to explore which elements of the education bundle are critical to maintaining intervention fidelity. If similar results can be realized using readily available nurses or other staff, then the impact of hospital-associated VTE can be significantly reduced.
Keywords: Anticoagulants, Health Education, Health Educators, Heparin, Low-Molecular-Weight, Nurse-Patient Relations, Primary Prevention, Vascular Diseases, Venous Thromboembolism
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