title: Patient education program for venous thromboembolism prevention in hospitalized patients.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. gpiazza@partners.org
authors.forename: Gregory
authors.initials: G
authors.lastname: Piazza
authors.forename: Thanh Nha
authors.initials: TN
authors.lastname: Nguyen
authors.forename: Ruth
authors.initials: R
authors.lastname: Morrison
authors.forename: Deborah
authors.initials: D
authors.lastname: Cios
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hohlfelder
authors.forename: John
authors.initials: J
authors.lastname: Fanikos
authors.forename: Marilyn D
authors.initials: MD
authors.lastname: Paterno
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D005260:Female; D006760:Hospitalization; D006801:Humans; D007267:Injections; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D010595:Pharmacists; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016312:Treatment Refusal; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants