Project Summary

This implementation project is complete.

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project put a blood clot prevention program, shown to reduce missed and refused doses of medicine, into standard practice at two hospitals.

An estimated 12 million patients are at risk for blood clots while they are in the hospital. Blood clots are a common cause of serious health problems or even death.

What was the goal of this implementation project?

Venous thromboembolism, or VTE, occurs when blood clots develop inside veins. Although anyone can get a blood clot, more than half of blood clots happen after surgery or a hospital stay. Medicines can help prevent VTE but missing even one dose can lead to blood clots. A PCORI-funded research study tested a program that alerts hospital staff when a patient misses a dose of the medicine so they can talk with the patient about preventing blood clots. The program reduced the number of patients who missed or refused doses of blood clot prevention medicine.

This implementation project put the tested program in place at two hospitals to decrease patients’ risk for blood clots.

What did this project do?

The project team put the blood clot prevention program in place at two Johns Hopkins Health System hospitals in Maryland: the Johns Hopkins Hospital (JHH) and Howard County General Hospital (HCGH).

The blood clot prevention program alerted nurses in real time when a patient missed a dose of their medicine. To make this work, the project team modified the hospital’s electronic health record, or EHR, system to automatically send a text message alert. After receiving the alert, nurses met with the patient and talked about blood clot prevention. They also gave the patient an educational handout and video and answered their questions. Nurse champions on each floor encouraged others to use the alert system.

The program also included online training for nurses to help them talk with patients about blood clot prevention. The team added this training as part of the professional education nurses receive.

The project team worked with each hospital’s nursing leaders to tailor the program so it would fit well within nurses’ regular work.

What was the impact of this project?

This project adapted the program to work as part of routine nursing care in two different types of hospitals. The program successfully improved the use of blood clot medicine in these hospitals.

During the project, nurses received text alerts for about 17,000 patients who had missed a dose of their medicine. The project team’s evaluation showed that after the program was put in place:

  • The number of patients in the hospital who received all their doses of blood clot medicine increased (by 14% at JHH and by 22% at HCGH).
  • The overall number of missed doses of medicine decreased (by 38% at JHH and by 31% at HCGH).
  • The number of missed doses due to patients refusing the medicine decreased (by 40% at JHH and by 33% at HCGH).

This project laid the groundwork for other hospitals and health systems interested in putting this program in place to reduce missed doses of blood clot medicine.

More about this implementation project:

Stakeholders Involved in This Project

  • National Blood Clot Alliance (NBCA)
  • North American Thrombosis Forum (NATF)
  • ClotCare
  • Armstrong Institute for Patient Safety and Quality (AIPSQ), Johns Hopkins Medicine

Publicly Accessible Project Materials

For more information about these materials, please contact the Project Team at [email protected].

The project team developed these materials, which may be available for free or require a fee to access. Please note that the materials do not necessarily represent the views of PCORI and that PCORI cannot guarantee their accuracy or reliability.

    Project Achievements

    • Adapted intervention to make it more scalable.
    • Accomplished EHR integration that is transferrable to other locations.
    • Demonstrated the feasibility of real-time EHR-based targeting of blood clot prevention education with 17,000 patients at risk for developing a blood clot.
    • Incorporated the program into standard care at an academic and community non-teaching hospital; both hospitals sustained the use of the program following project completion.
    • Developed an implementation toolkit (e.g., information aids for nursing staff, patient education materials) that is transferrable to other settings.
    • Offered an online nursing education course that was available throughout the health system; the course is available to others for a nominal fee.
    • Following completion, the program was included as a 2020 Strategic Priority for the Department of Nursing at JHH.

    Implementation Strategies

    • Promoted shared decision making.
    • Used a clinical decision support tool.
    • Adapted the program to work with sites’ existing resources and workflows.
    • Integrated a real-time alert system into the electronic health record.
    • Provided sites with tools to support implementation.
    • Provide educational materials for patients, as handout and video.
    • Conducted educational meetings for clinicians.
    • Developed and used online nursing education modules.
    • Used a phased implementation approach.
    • Provided sites with audit and feedback reports.
    • Identified and prepared nursing champions at sites.
    • Provided technical assistance to sites, including consultation.

    Evaluation Outcomes (selected)

    To document implementation:

    • Barriers and facilitators
    • Intervention fidelity
    • Sustainability

    To assess healthcare and health outcomes:

    • Number of patient hospital admissions in which all doses of VTE prophylaxis were administered
    • Proportion of prescribed doses not administrated due to patient refusal
    • Proportion of prescribed doses not administered for other reasons

    Project Information

    Elliott Haut, MD, PhD
    Johns Hopkins University
    Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis

    Key Dates

    February 2020

    Study Registration Information

    Initial PCORI-Funded Research Study

    This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Can Nurse and Patient Education Reduce Missed Doses of Medications to Prevent Blood Clots in Hospitals?

    Related PCORI Dissemination and Implementation Project

    This implementation project is related to another PCORI-funded Dissemination and Implementation project: Implementing Best-Practice, Patient-Centered Venous Thromboembolism (VTE) Prevention in Trauma Centers


    Project Status
    State State The state where the project originates, or where the primary institution or organization is located. View Glossary
    Project Details Type
    Last updated: May 3, 2023