Original Investigation 

Implementing a Patient-Centered Education Bundle to Improve Venous Thromboembolism Prevention

Elliott R. Haut, Oluwafemi P. Owodunni, Dauryne L. Shaffer, et al

JAMA Surg Published Online: October 8, 2025

doi: 10.1001/jamasurg.2025.4136

Key Points

Question  Does a comprehensive intervention to address missed doses of venous thromboembolism (VTE) prophylaxis reduce missed doses in a community hospital?

Findings  This cohort study implemented and assessed a nurse education module combined with a patient-centered education bundle triggered by a real-time alert when a prescribed dose of VTE prophylaxis was missed. There were significant reductions in all missed doses and in patient refusal of VTE prophylaxis doses after the intervention.

Meaning  Interventions to prevent missed doses of VTE prophylaxis initially tested and used at a large academic medical center can successfully be implemented at smaller community hospitals without research infrastructure.

Abstract

Importance  Venous thromboembolism (VTE) is one of the most common causes of preventable harm in hospitals. While numerous efforts have been made to increase prescription of evidence-based VTE prophylaxis for hospitalized patients, many prescribed doses are either refused or missed for other reasons. Successful interventions to decrease these missed doses have been developed and tested in academic hospitals, but it remains unclear if these interventions can be scaled and implemented in community hospitals.

Objective  To disseminate and implement an evidence-based, comprehensive strategy to reduce missed doses of VTE prophylaxis.

Design, Setting, and Participants  This prospective cohort study was conducted on 7 floors across a community hospital within a large health system. Participants were all hospitalized adult patients admitted from July 1, 2018, to June 30, 2019 (preintervention), and July 1 to December 31, 2019 (postintervention), who were prescribed at least 1 dose of pharmacologic VTE prophylaxis. Data analysis was performed from January 2020 to January 2022.

Interventions  Implementation of a dynamic, scenario-based nurse education module combined with a patient-centered education bundle triggered by a real-time alert sent to the charge nurse when a dose of prescribed VTE prophylaxis was not administered.

Main Outcomes and Measures  Primary outcome was the proportion of any missed doses of prescribed pharmacologic prophylaxis. Secondary outcomes were proportions of doses refused and missed for reasons other than refusal.

Results  A total of 15 752 patients were included, 8714 (55.3%) female and 7038 (44.7%) male. The mean (SD) age was 63.9 (18.5) years. Missed doses decreased significantly in the postimplementation period, 10 643 of 82 269 doses (12.9%) vs 2718 of 29 338 doses (9.3%) (OR, 0.60; 95% CI, 0.55-0.66). There were significant improvements in patient refusal (7280 doses [8.8%] vs 1696 doses [5.8%]; OR, 0.51; 95% CI, 0.46-0.58) and doses missed for reasons other than patient refusal (3363 [4.1%] vs 1022 [3.5%]; OR, 0.87; 95% CI, 0.77-0.99). There was no difference in the proportion of patients with VTE (9 patients [0.08%] vs 6 patients [0.1%]; P = .58).

Conclusion and Relevance  This study found that providing engaging education to frontline nurses and just-in-time, patient-centered education to patients significantly improved administration and acceptance of prescribed VTE prophylaxis for hospitalized patients across an entire community hospital. These findings show that proven interventions developed at academic hospitals can be successfully implemented broadly in community hospitals.