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Online Education Increases Best-Practice Use of Blood Thinners

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Online Education Increases Best-Practice Use of Blood Thinners

Online Education Increases Best-Practice Use of Blood Thinners
Chanapa Tantibanchachai

Date: 10/27/2017

Well-designed online education can increase the appropriate use of blood thinners, preventing potentially lethal blood clots. This was the finding of a yearlong study funded by the Patient-Centered Outcomes Research Institute (PCORI) and conducted with more than 900 nurses at The Johns Hopkins Hospital. A report on the study was published in PLOS ONE in August.

The research was spurred by a documented need to boost administration of prescribed heparin and other blood thinners to prevent venous thromboembolism (VTE), as well as data showing that patients’ refusal of the drugs frequently resulted in nurses not administering them. VTE is a blood clot that starts in a vein, often in a limb. It kills more than 100,000 people annually when a clot breaks off and travels to the lung — a total that is more than the number of lives taken by breast cancer, AIDS and motor vehicle collisions combined.

“While injectable blood-thinning drugs, such as heparin, can prevent VTE, upwards of 15 percent of prescribed doses are never administered to hospitalized patients, most often due to patient refusal,” says Brandyn Lau, assistant professor of radiology and radiological science at the Johns Hopkins University School of Medicine and the paper’s first author.

For the study, the team developed two online education modules about the importance of VTE prevention and tactics for better communicating its importance to patients. One module was “dynamic,” involving a scenario-based experience in which nurses selected responses within given clinical scenarios, such as how to respond to a patient who was refusing a prophylactic medication dose. In the “static” arm, nurses were shown a PowerPoint slideshow with traditional voice-over explaining the information.

“We teach in hopes of improving patient care, but there’s actually very little evidence that online professional education can have a measurable impact. Our results show that it does,” says Elliott Haut, associate professor and vice chair of quality, safety and service for the Department of Surgery.

To track nonadministration rates, the researchers retrieved data on VTE-preventing medication administration from the hospital’s electronic health records system. The team collected data for one year and divided it into three time periods: baseline, education intervention and post-education. During the entire study period, 214,478 doses of blood clot-preventing medications were prescribed to patients on the 21 hospital floors.

After education, overall nonadministration rates were reduced from 12.4 percent to 11.1 percent. Nurses who completed the dynamic education module, however, saw a greater reduction in nonadministration (10.8 percent to 9.2 percent) than those who completed the static education module (14.5 percent to 13.5 percent).

“Now that we’ve shown the modules can be effective in improving practice, we want to make them available to the more than 3 million nurses practicing in the U.S.,” Haut says.