Clinical research study
Patient Education Program for Venous Thromboembolism Prevention in Hospitalized Patients

https://doi.org/10.1016/j.amjmed.2011.09.012Get rights and content

Abstract

Purpose

Up to 15% of clinician-ordered doses of injectable pharmacological prophylaxis to prevent venous thromboembolism are not administered. Patient refusal accounts for nearly 50% of these omitted doses. We conducted a prospective cohort study to determine whether a patient education program would improve medication adherence to clinician-ordered injectable prophylactic anticoagulation.

Methods

We identified 528 hospitalized patients ordered to receive injectable pharmacological venous thromboembolism prophylaxis. We evaluated the impact of pharmacist-led patient education sessions on medication adherence (defined as the ratio of doses administered to doses scheduled) compared with our historical cohort.

Results

Individualized patient education sessions were conducted within 24 hours of the initial order for prophylactic anticoagulation in 99% of patients. Adherence to clinician-ordered pharmacological venous thromboembolism prophylaxis was higher after the patient education program than in our historical cohort (94.4% vs 89.9%, P <.0001). The proportion of patients receiving 100% of scheduled doses of injectable pharmacological venous thromboembolism prophylaxis was higher after our novel patient education program than in our historical cohort (73.7% vs 62.4%, P = .001). Patient refusal as a reason for omitted doses was less frequent after the patient education program (29.3% vs 43.7%, P = .001).

Conclusion

Pharmacist-led individualized patient education sessions were associated with higher medication adherence to clinician-ordered injectable pharmacological venous thromboembolism prophylaxis and a reduction in patient refusal as a reason for omitted doses. A randomized controlled trial to evaluate the impact of a patient education program on medication adherence to pharmacological venous thromboembolism prophylaxis is warranted.

Section snippets

Patient Population

Brigham and Women's Hospital is a 793-bed acute tertiary care facility providing medical and surgical care for patients with general medical, cardiothoracic, orthopedic, oncologic, neurologic, obstetric and gynecologic, neonatal, urologic, and gastrointestinal conditions. Brigham and Women's Hospital utilizes a Medical Informatics System that integrates an online medical record, computerized provider order entry, and an electronic medication administration record.

Identification of Study Subjects

Using our event-based rules

Baseline Demographics and Clinical Characteristics

Patient education sessions were conducted for all 528 hospitalized patients enrolled in the study. Subjects enrolled in the patient education program had a median age of 58 years and a median venous thromboembolism risk score of 3 (Table 1). The median length of stay was 4 days.

Pharmacological Venous Thromboembolism Prophylaxis

Subcutaneously administered unfractionated heparin (54.9%) was the most frequently prescribed form of pharmacological venous thromboembolism prophylaxis followed by subcutaneously administered dalteparin (44.7%) (Table 2

Discussion

We found that a pharmacist-led individualized patient education program resulted in significantly higher medication adherence to clinician-ordered injectable pharmacological venous thromboembolism prophylaxis than in our historical cohort. The patient education program was associated with a one-third lower frequency of patient refusal as a reason for omitted doses of clinician-ordered injectable prophylactic anticoagulation. We found that the pharmacist-led patient education program was

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    Funding: This study was funded, in part, by an unrestricted clinical research grant from sanofi-aventis. Dr Goldhaber (Principal Investigator), Thanh Nha Nguyen (research pharmacist), and Ruth Morrison (research nurse) were partially compensated with these funds. Dr Piazza is supported by a Research Career Development Award (K12 HL083786) from the National Heart, Lung, and Blood Institute (NHLBI).

    Conflict of Interest: Dr Goldhaber receives clinical research grant support from sanofi-aventis. None of the other authors have any conflicts of interest to disclose.

    Authorship: All of the authors had access to the data and participated in the writing of the manuscript.

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