Background: Venous thromboembolism (VTE) prophylaxis is an important aspect of patient safety for the hospitalized population; however prophylaxis administration is hindered by a variety of factors, including patient refusal. Bedside nurses have the opportunity to educate patients and to encourage them to receive VTE prophylaxis. We sought to determine if training nurses on the importance of VTE prevention will improve the rates of missed and patient-refused doses of pharmacologic prophylaxis.
Methods: This longitudinal quality improvement study was performed at an 805-bed urban tertiary teaching hospital. Bedside nurses in the general practice units, including 3 medical and 2 surgical units, underwent an in-service training that was focused on the prevention of VTE. The education was focused on the administration of prophylaxis on the days of admission and discharge, reinforcement that ambulation is not a substitute for administration, and recommendation of notifying physicians of any patient refusals. The rates of missed and patient-refused doses of pharmacologic prophylaxis during the three weeks before and the three weeks after the intervention were compared. Statistical analysis was done using chi-squared test.
Results: A total of 1952 patient-days were reviewed prior to intervention and 2050 patient-days afterwards. As seen in Figure 1, medical and surgical units had similar rates of refusal prior to education (p = 0.32). Overall, missed VTE prophylaxis doses totaled 427 before and 414 after (p = 0.29). Patients refused a total of 255 doses before and 302 doses after the in-service training (p = 0.19). In medical units, there was a 42% increase in the number of refusals per 100 patient-days after intervention (p = 0.003). In the surgical units, there was a 28% decrease in the number of refusals per 100 patient-days (p = 0.03).
Conclusions: In-service training for nurses on VTE prevention improved the rates of patient-refused doses of pharmacologic prophylaxis in surgical units, but not in medical units. Further studies are needed to understand the difference in performance outcomes between both groups.