PCORI funds Dissemination and Implementation projects to increase awareness and promote the use of PCORI research findings to improve healthcare practices and health outcomes. This project was funded to conduct dissemination and implementation activities for the results of the research project: Can Nurse and Patient Education Reduce Missed Doses of Medications to Prevent Blood Clots in Hospitals?
What research finding is this project disseminating?
The PCORI research study tested a program to help patients in the hospital make informed decisions about taking medication to prevent venous thromboembolism (VTE), or blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE causes more than 100,000 deaths per year in the United States. The program had two parts:
- Researchers worked with nurses on how to talk with patients about preventing blood clots.
- Any time a patient missed or refused a dose of VTE medication, a health educator received a real-time alert and followed up with a patient visit. The health educator discussed VTE prevention with the patient or provided an educational paper handout or video.
The research team found that the program reduced the number of times patients did not take blood clot prevention medicine for any reason by 42 percent. The program reduced the number of times patients refused to take blood clot prevention medicine by 45 percent.
Why is this research finding important?
Blood clots are a common cause of sickness and death among patients in the hospital. However, blood clots are also largely preventable, with highly effective medicines available. Successful efforts have improved the rates at which doctors prescribe these medications for hospital patients at risk of VTE. However, the researchers previously found that at their hospital, 12 percent of prescribed doses were missed—most often because patients declined the recommended medicine. Many patients are unaware of what blood clots are, how to prevent them, their own risk for blood clots, or the possible consequences of a blood clot.
The research team’s success in decreasing patient refusal of preventive medication and reducing the overall rate of missed doses offers promise for reducing VTE and deaths that result from blood clots.
What is the goal of the dissemination project?
This dissemination project will refine, adapt, and extend the research study’s VTE prevention program to make it easy to implement in different hospital settings across the country.
What is the project team doing?
The project team is expanding its program to the entire inpatient population at the large teaching hospital (The Johns Hopkins Hospital) where the research study took place. In addition, the team is implementing it in a medium-sized community hospital, Howard County General Hospital.
Nurses in the target hospitals are receiving training on VTE prevention as part of their annual hospital-based professional education. In addition, each hospital floor will have a VTE prevention champion—a nurse or other member of the healthcare team who will receive an alert via the electronic medical record each time a patient misses a dose of preventive medication, and who will ensure that the patient is offered consultation and materials about VTE prevention. The project team will work with the champions, as well as all hospital nurses, to promote effective communication approaches for discussing harms of blood clots and benefits of blood clot prevention medicine with patients. In addition, all patients at the two hospitals can access a video on VTE prevention through the hospital television system upon admission to the hospital. You can watch the video here at http://www.bit.ly/bloodclots.
How will the project team evaluate its dissemination activities?
The project team will track
- Number of missed doses of prescribed blood clot prevention medicine
- Number of doses of prescribed blood clot prevention medicine that were missed because the patient refused the medicine
- Number of new blood clots occurring within 30 days of patient admission for all patients at the two hospitals.
The team will compare rates of VTE before and after the program starts to assess its impact.
The project team will gather feedback from patients, patients’ families, doctors, nurses, pharmacists, and others to improve the program during the project period.
How is the project team involving patients and others in this dissemination project?
While creating the educational resources, the researchers asked patients what they want to learn about blood clots. The project team is also gathering feedback from patients and the healthcare team to inform program decisions and improvements.
The project team is working with the following organizations on this dissemination project:
- The National Blood Clot Alliance, the North American Thrombosis Forum, and ClotCare. These organizations represent patient groups for blood clot prevention.
- Patient and family advisory councils at the two hospitals undertaking the project. These groups focus on patient education and safety.
- The Armstrong Institute for Patient Safety and Quality. This organization’s goal is reducing harm to patients.
Learn more about PCORI’s Dissemination and Implementation program here.
Original PCORI-funded Research Project
Note: Results from the original project have completed PCORI’s Peer Review and are available here.