Patient education initiative prevents dangerous blood clots

A simple worksheet for patients recovering from surgery shows them the importance of clot-preventing medication.

Venous thromboembolism, or VTE, is the formation of blood clots in a vein, most often in the legs, and can become a life-altering postoperative complication. If a clot breaks free and lodges in the lungs, it can block blood flow and even become fatal.

Patients who have undergone surgery and recover in the hospital are at a higher risk for developing VTE. When patients sit or lie down for extended periods, circulation in the legs significantly slows. Blood can pool and begin to clot. Health care providers work to prevent this by administering appropriate doses of anticoagulant medications to high-risk patients. Unfortunately, patients aren’t always aware of the importance of these injections and refuse the medication to avoid additional needle sticks.

Jin Ra, MD, an acute care surgeon, and Heather Kendall, an analyst in Quality Management, began following UF Health Jacksonville’s rates of postoperative VTE occurrences in July 2016. They found about two or three cases per month — three times the rate of comparable health institutions.

“When we broke it down, we knew general surgery patients were where the majority of VTEs occurred,” Ra said. “Patient and family refusal was the main cause of noncompliance based on the data from a patient survey we conducted.”

To combat the refusal rate of the injections, Ra and her colleagues developed an easy-to-read educational sheet to give every patient scheduled for surgery and designated high-risk for VTE. It communicates the importance of accepting each dose of medication and mentally prepares patients for the injections.

“We thought that would be helpful for the patient, so it’s not a surprise,” Ra said. “They will know why someone is coming into their room with needles and the purpose of the injections, reducing the refusal rate.”

The same sheet is being used to educate nurses and physicians about the necessity of the anticoagulant doses.

“No matter who the patient talks to, they will hear the same language and description to reinforce the importance of the medication,” Ra said. “There are examples of residents coming by and explaining it to the patient, and now they’re accepting of the medication. Those are all positive signs we’re working together and doing the things we need to.”

The initiative began with nurse and physician education in November 2016. By December, VTE rates dropped below the expected amount, which is a risk-adjusted benchmark tailored to UF Health Jacksonville’s patient population. During many months, there are no VTE cases, but up to two still occur on occasion.

“With high-risk patients, they may still develop it despite everything we do,” Ra said. “We don’t know exactly what that rate is yet, but on our end, we have to do everything we can to minimize it. A lot of patients, once they are educated about it, are accepting of the additional discomfort of being injected. They understand why it is important for their health.”

Ra’s ultimate goal is to keep the worksheet updated and to make it a permanent part of both patient and provider education going forward. “For this pilot, we focused on our surgical patients with cancer because they’re automatically high-risk,” she said. “Once everyone is satisfied with the outcome, this will become a wider initiative for more patients.”