Disseminating a Patient Centered Venous Thromboembolism Prevention Bundle

摘要 静脉血栓栓塞症(VTE)已被称为可预防的危害的唯一主要原因 AHRQ的住院患者。许多研究都集中在改进预防VTE的处方上 给住院病人用药；然而，处方并不能保证给药。我们发现VTE 预防用药不坚持在住院患者中非常普遍；在一些楼层患者 只有5%的剂量漏掉了，而其他剂量的漏掉了近40%。记录最多的非 管理就是耐心地拒绝。在可预防的VTE患者中(定义为 接受预防)，大多数(72%)开出了最佳预防处方，但错过了一剂或多剂。 传统上，针对不遵守用药规定的干预措施一直只关注门诊患者 环境，将其普适性限制在住院患者。2013年，我们得到了以患者为中心的资助 结果研究所(PCORI)开发和提供以患者为中心的循证干预 使用交易性电子健康记录数据实时捆绑，以提高对规定VTE的遵从性 住院病人的预防措施。这项干预的目标是使患者能够了解情况 提高住院患者预防VTE用药依从性的对策 异质环境中的患者。我们的研究显示出显著的改善，40% 不给予药物性静脉血栓栓塞剂预防剂量的减少，并减少50%的患者拒绝。 我们在8个不同楼层的值班护士的真实环境中进一步测试了这一干预措施 患者教育捆绑包交付；不坚持减少47%，患者拒绝减少57%。 我们将在不同的医院环境中扩大我们的干预，包括主要的学术医疗 中心和两家社区医院。在这些医院之间，VTE用药不坚持的范围从 8.8%至17.8%。我们将为前线护士提供互动的、在线的、基于情景的教育 VTE预防对住院患者的重要性，并将吸引处于最高水平的住院患者 预防VTE的风险是使用以患者为中心的教育干预捆绑包不坚持用药。我们的 主要结果是给予静脉血栓栓塞症预防用药剂量的比例。我们的次要 结果包括患者拒绝接受静脉血栓栓塞症预防药物治疗的发生率，住院- 使用经过验证的AHRQ患者安全指标-12与VTE相关，以及VTE患者的比例 错过规定剂量的预防措施的人。 拟议研究的成功完成将使患者能够在知情的情况下做出决定 他们的VTE预防性护理，提高VTE预防用药的依从性，并改善患者的交付- 为跨不同临床环境的住院患者提供集中、无缺陷的VTE预防。

Summary Venous thromboembolism (VTE) has been called the single leading cause of preventable harm in hospitalized patients by AHRQ. Numerous studies have focused on improving prescription of VTE prophylaxis medication for hospitalized patients; however, prescription does not ensure administration. We found that VTE prophylaxis medication nonadherence among hospitalize patients is highly prevalent; on some floors patients miss only 5% of doses and on others nearly 40%. The most frequently documented reason for non- administration is patient refusal. Among patients with preventable VTE (defined as VTE in patients not receiving prophylaxis), the majority (72%) were prescribed optimal prophylaxis but missed one or more doses. Classically, interventions targeting medication nonadherence have been focused exclusively on outpatient settings, limiting their generalizability to hospitalized patients. In 2013, we were funded by the Patient Centered Outcomes Research Institute (PCORI) to develop and deliver a patient-centered, evidence-based intervention bundle in real-time using transactional electronic health record data to improve adherence to prescribed VTE prophylaxis for hospitalized patients. The goal of this intervention was to empower patients to make informed decisions about their VTE preventive care and improve VTE prophylaxis medication adherence in hospitalized patients in heterogeneous environments. Our research study showed significant improvement, with a 40% decline of nonadministration of pharmacologic VTE prophylaxis doses, and a 50% reduction in patient refusal. We further tested this intervention in a real-world setting where charge nurses on 8 different floors were given the patient education bundle to deliver; nonadherence decreased 47% and patient refusal decreased by 57%. We will scale up our intervention across diverse hospital settings, including a major academic medical centers and two community hospitals. Between these hospitals, VTE medication nonadherence ranges from 8.8% to 17.8%. We will deliver interactive, online, scenario-based education to frontline nurses regarding the importance of VTE prevention for hospitalized patients and will engage hospitalized patients who are at highest risk of VTE prophylaxis medication nonadherence using a patient-centered education intervention bundle. Our primary outcome is the proportion of administered VTE prophylaxis medication doses. Our secondary outcomes include the incidence of patient refusal for VTE prophylaxis medication, incidence of hospital- associated VTE using the validated AHRQ Patient Safety Indicator-12, and the proportion of patients with VTE who miss doses of prescribed prophylaxis. Successful completion of the proposed research will empower patients to make informed decisions about their VTE preventive care, increase VTE prophylaxis medication adherence, and improve delivery of patient- centered, defect-free VTE prevention to hospitalized patients across heterogeneous clinical settings.