Prescriber knowledge and attitudes regarding non-administration of prescribed pharmacologic venous thromboembolism prophylaxis

Abstract

Pharmacologic venous thromboembolism (VTE) prophylaxis is important patient safety practice in hospitalized patients. However, a substantial number of ordered doses are not administered. Patient and nursing attitudes and behaviors can influence whether a patient receives a dose. The objective of this single center study was to evaluate prescriber knowledge and attitudes regarding missed doses of pharmacologic VTE prophylaxis. An anonymous, 9-question survey was administered to internal medicine and general surgery resident physicians. The survey captured prescriber opinions on issues related to non-administration of VTE prophylaxis. Thirty-two percent of medicine residents compared with 3 % of surgery residents felt pharmacologic VTE prophylaxis was not necessary in an independently ambulating patient (P < 0.001). Medicine residents were more likely to agree that it is appropriate for nurses to make clinical decisions to determine whether a dose of pharmacologic VTE prophylaxis should be administered to a patient (24 vs. 0 %, P < 0.001). Study findings indicate the need for additional resident physician education. Further investigation is needed to assess these beliefs and ensure patients receive necessary VTE prophylaxis.

The Johns Hopkins Venous Thromboembolism Collaborative: Multidisciplinary team approach to achieve perfect prophylaxis

“…In a survey of 122 resident physicians, we found significant differences in clinical practice between medicine and surgery residents. Medicine residents were more likely to believe that VTE prophylaxis was overprescribed, and that it was appropriate for nurses to make judgement calls about whether patients needed the prophylaxis that was prescribed . In a mixed methods study that included a written survey and qualitative observations of nursing practice, we found that some nurses presented pharmacologic VTE prophylaxis injections as optional to patients.…”

“…Medicine residents were more likely to believe that VTE prophylaxis was overprescribed, and that it was appropriate for nurses to make judgement calls about whether patients needed the prophylaxis that was prescribed. 21 In a mixed methods study that included a written survey and qualitative observations of nursing practice, we found that some nurses presented pharmacologic VTE prophylaxis injections as optional to patients. Furthermore, nurses on units where nonadministration was higher were more likely to believe that VTE prophylaxis was prescribed for patients unnecessarily, and that they could use their clinical judgement to determine when it was appropriate to omit doses of pharmacologic prophylaxis.…”

“…Over the past 10 years, we have mentored countless medical students, public health graduate students, nursing students, residents, and postdoctoral fellows in research projects that have resulted in numerous high-quality publications. Trainees have helped to dispel staff concerns about patient falls in connection of intermittent pneumatic compression devices, 25 identify the weaknesses of current publicly reported VTE measures, [26][27][28][29] identify opportunities to improve VTE prevention practices within clinical specialties, [30][31][32] define the role of surveillance bias in VTE outcomes reporting, [33][34][35] discover and fully explore the important problem of missed doses of VTE prophylaxis, 18,[21][22][23]36 and summarize knowledge about VTE prevention via systematic reviews and meta-analyses. [37][38][39] These collaborations have been a classic win-win.…”

Thoracic Epidural Anesthesia and Prophylactic Three Times Daily Unfractionated Heparin Within an Enhanced Recovery After Surgery Pathway for Colorectal Surgery

“…Inconsistencies among and between providers may lead to variable practices, especially in management of conditions that are perceived as "low risk" such as holding a single dose of a medication. [29][30][31][32] In addition, the multidisciplinary nature of surgical patient care, wherein surgical, anesthesia, acute pain, and other consulting providers are involved can create confusion regarding which service takes charge of which element in care. In reviewing the nursing notes, most of the doses held for epidural had a specific comment associated with the epidural being removed.…”

Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: A randomized clinical trial

“…traveling nurse, float nurse) were excluded from this study. Because of known differences between medical and surgical floors in VTE prophylaxis administration practice and culture,[ 14 , 16 , 19 – 21 ] floors were stratified by department (i.e. medicine and surgery) for randomization.…”