Why do Patients Refuse VTE Prophylaxis? Improving Nurse-Patient Conversations at the Bedside

Venous thromboembolism (VTE) are blood clots that form in a deep vein and can travel to the lungs. VTE is the leading cause of preventable inpatient death. There are three ways to help decrease a patient’s risk for VTE: walking, wearing sequential compression devices (SCDs), and taking medication to help avoid blood clotting. Patients can refuse one or more of these components which can increase their VTE risk. Data from our hospital show that patient refusal rates vary among nurses and across inpatient units. In addition, previous research shows that nurses can influence patient compliance with VTE prophylaxis. We conducted focus groups with nurses to identify barriers to providing VTE prophylaxis, and then created and pilot tested a customized intervention bundle to decrease patient refusal rates on four nursing units. The bundle components are: 1. Patient education materials 2. Online, interactive nurse VTE educational module 3. Unblinded unit- and nurse-level patient refusal rate reports 4. Educational signage on units promoting walking 5. Interactive simulation sessions to equip nurses to counsel patients Based on our pilot program, we aim to design, test, and implement a nurse-focused mastery learning curriculum to reduce patient refusal of VTE prophylaxis that is generalizable and sustainable.