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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Mobile Patients Miss and Refuse More Doses of Venous Thromboembolism (VTE) Prophylaxis Brandyn D.Lau1, 2, 3, 4, Erik H.Hoyer1, 2, Dauryne L.Shaffer5, Peggy S.Kraus5, Elliott R.Haut1, 2, 3, 4, Michael B.Streiff1, 2. 1Johns Hopkins School of Medicine, Baltimore, MD, USA.2Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA.3Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.4Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.5Johns Hopkins Hospital, Baltimore, MD, USA |
Abstract
Background: Venous thromboembolism (VTE) is a common cause of preventable harm among hospitalized patients. Numerous interventions have focused on improving prescription of VTE prophylaxis for at-risk patients. Despite these efforts, many hospitalized patients miss doses of prescribed VTE prophylaxis. Studies have shown that missing doses of VTE prophylaxis is associated with an increased risk of developing VTE. The primary reason for missed doses is patient refusal, which multiple qualitative studies have shown is heavily influenced by nurse attitudes and beliefs that patients who are actively ambulating may not need the prescribed pharmacologic VTE prophylaxis. These beliefs are based on the assumption that ambulation is effective for preventing VTE in hospitalized patients; however, a systematic review found no evidence demonstrating that ambulation is effective for preventing VTE in hospitalized patients. Qualitative studies suggest that nurses believe that patients who are ambulating are at lower risk for VTE and therefore nurses may be less likely to administer prescribed VTE prophylaxis for patients with greater mobility. Objectives: The objective of this study is to assess pharmacologic VTE prophylaxis administration among mobile vs. immobile hospitalized, medically ill patients. Methods: This was a retrospective cohort study at The Johns Hopkins Hospital, an urban, academic medical center in Baltimore, Maryland. All hospitalized, medically ill patients admitted from January 1 through April 30, 2019 were included. The Johns Hopkins Highest Level of Mobility (JH-HLM) is an 8-point validated scoring system used to record the highest observed patient mobility level and was used to categorize patients as immobile (HLM ≤ 3) or mobile (HLM ≥ 4). Documentation of the JH-HLM score is required for all hospitalized patients at least once during each nursing shift based on direct observation. We defined immobility as bedrest for ≥ 3 consecutive days (Padua VTE risk assessment model) or ≥ 7 consecutive days (IMPROVE VTE risk assessment model). Our primary outcome was the proportion of doses of prescribed VTE prophylaxis not given. Our secondary outcomes were proportions of doses of prescribed VTE prophylaxis documented as patient refused or missed for reasons other than refusal. Results: We included 4,021 patients. There were 2,737 (68.1%) categorized as mobile during hospitalization based on Padua criteria, and 3,636 (90.4%) were mobile based on IMPROVE criteria. Mobile patients missed significantly more doses of prescribed prophylaxis than immobile patients based on Padua (18.9% vs. 12.0%, p<0.001) and IMPROVE criteria (17.3% vs. 9.0%, p<0.001). Mobile patients refused significantly more doses of prescribed prophylaxis based on both Padua (15.0% vs. 9.2%, p<0.001) and IMPROVE criteria (13.7% vs. 6.4%, p<0.001, Figure). Conclusions: Mobile patients miss and refuse significantly more doses of prescribed VTE prophylaxis, quantitatively confirming previous qualitative studies that nurses are less likely to administer prescribed VTE prophylaxis for patients who are ambulating. By implementing comprehensive education for nurses and patients, hospitals can improve the consistent administration of VTE prophylaxis, ultimately improving patient outcomes and reducing preventable harm.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.