Education Bundle to Decrease Patient Refusal of VTE Prophylaxis
Condition: Venous Thromboembolism; Deep Venous Thrombosis; Pulmonary Embolism
MeSH terms: Pulmonary Embolism; Thrombosis; Embolism; Thromboembolism; Venous Thromboembolism; Venous Thrombosis
Study type: Interventional

Summary: 
      The investigators have recently developed a registry of missed doses of VTE prophylaxis that
      includes retrospective data on missed doses of VTE prophylaxis. To decrease rates of VTE
      prophylaxis refusal, the group has developed a patient-centered education bundle that will be
      delivered as an in-person, 1-on-1 discussion session with a nurse educator. Supporting
      education materials include a 2-page education sheet and an educational video.

      The investigators hypothesize that patient refusal of VTE prophylaxis is associated with
      significant knowledge gaps among patients regarding patients' risk of developing VTE and the
      benefits of VTE prophylaxis and that delivering an education bundle to patients that refuse
      VTE prophylaxis will improve compliance with VTE prophylaxis and decrease rates of VTE.
    

Detailed description: 
      Background

      This research group's published pilot study reported that nearly 12% of prescribed doses of
      pharmacologic VTE prophylaxis are not administered and almost 60% of missed doses are due to
      patient or family member refusal. Fanikos et al found that 44% of missed doses of VTE
      prophylaxis were due to patient refusal. In a survey of 500 recently hospitalized patients,
      the National Blood Clot Alliance found that only 28% and 15% respectively had basic knowledge
      of deep venous thrombosis (DVT) or pulmonary embolism (PE) despite the fact that 15% of
      participants had a history and 43% had a family history of either condition.

      Given these high rates of patient refusal of VTE prophylaxis and significant knowledge gaps
      regarding VTE, there is an urgent need to educate patients and families on the importance and
      benefits of compliance with VTE prophylaxis.

      The proposed patient-centered education bundle will be delivered as an in-person, 1-on-1
      discussion session with a nurse educator. Supporting education materials include a 2-page
      education sheet and an educational video.

      The investigators hypothesize that patient refusal of VTE prophylaxis is associated with
      significant knowledge gaps among patients regarding patients' risk of developing VTE and the
      benefits of VTE prophylaxis and that delivering an education bundle to patients that refuse
      VTE prophylaxis will improve compliance with VTE prophylaxis and decrease rates of VTE.

      Objectives

      Primary objective: is to determine the impact of delivering a patient education intervention
      bundle on rates of VTE prophylaxis non-administration.

      Secondary objective: is to determine the impact of delivering a patient education
      intervention bundle on rates of VTE.

      Methods

      The investigators have developed a real-time alert that notifies a member of the research
      team whenever a patient misses patients' dose of VTE prophylaxis. This interventional study
      will take place on on four hospital floors. Whenever a nurse educator receives an alert from
      any of the included floors indicating that a dose of VTE prophylaxis has been missed, she/he
      will visit the floor, and approach the nurse in charge of that patient to find out the reason
      for the missed dose. If the dose was missed as a result of patient refusal, the nurse
      educator will visit the patient and deliver the education bundle comprised of: 1) a
      one-on-one education session, 2) the patient education sheet and 3) the patient education
      video depending on patient preference. The intervention will be in real time for doses missed
      on business days between 8.00am and 4.00pm and at the start of the next business day for
      doses missed during non-business hours or on weekends. The investigators anticipate that the
      study will continue for 5 years and the investigators anticipate a total of 1000 patients
      during the study duration.
    

Intervention name(s): Patient-centered education bundle
Intervention type(s): Behavioral
Intervention description(s): A patient-centered education bundle that will be delivered as an in-person, 1-on-1 discussion session with a nurse educator. Supporting education materials include a 2-page patient education sheet and a patient education video.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: venous thromboembolism; deep venous thrombosis; pulmonary embolism; blood clots