title: Hidden Barriers to Delivery of Pharmacological Venous Thromboembolism Prophylaxis: The Role of Nursing Beliefs and Practices.
abstract: Standardized electronic order sets for venous thromboembolism prophylaxis have increased the proportion of patients receiving venous thromboembolism prophylaxis. However, ordering venous thromboembolism prophylaxis does not ensure consistent administration.
  
  
  
  To explore causes of variability in the rate of administration of ordered doses of pharmacological venous thromboembolism prophylaxis among hospital units.
  
  
  
  Mixed methods study, including qualitative observation and quantitative nursing survey administration.
  
  
  
  Nurses included in observations were practicing on an inpatient unit, caring for patients with orders to receive venous thromboembolism prophylaxis consisting of low-dose unfractionated heparin or low-molecular weight heparin. Nurses on 12 inpatient units with disparate rates of administration were included in the survey.
  
  
  
  Qualitative observation data were collected until thematic saturation was achieved. Survey was conducted to identify beliefs and practices surrounding nursing administration of venous thromboembolism prophylaxis.
  
  
  
  During observations, some nurses presented pharmacological venous thromboembolism prophylaxis to their patients as an optional therapy. Nurses on low-performing units are more likely to believe that pharmacological venous thromboembolism prophylaxis is ordered for patients who do not require it. More often, they also acknowledge that nurses use their clinical decision-making skills to determine when to omit unnecessary doses of prescribed venous thromboembolism prophylaxis.
  
  
  
  Nurses on units with low administration rates often believe they have the skills to determine which patients require pharmacological venous thromboembolism prophylaxis. They are also more likely to believe that ordered doses are discretionary and offer the medication as optional to patients.
authors.affiliation: From the Department of Pharmacotherapy, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Stacy
authors.initials: S
authors.lastname: Elder
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Hobson
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Leigh E
authors.initials: LE
authors.lastname: Efird
authors.forename: Peggy S
authors.initials: PS
authors.lastname: Kraus
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Lehmann
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Shermock
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003469:Culture; D003695:Delivery of Health Care; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D009726:Nurses; D057184:Practice Patterns, Nurses'; D055656:Prescriptions; D012307:Risk Factors; D012647:Self-Assessment; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin