Improving Administration of Blood Thinner Drugs through an Online Course for Nurses

Patients’ refusal of blood thinners can influence a nurse’s decision to administer the drugs, but an online educational program could help to address this issue. A study of the online course, which was published in the journal PLOS ONE, found that the program helped nurses communicate with patients to improve rates of administration of blood thinner drugs like heparin.

Blood thinners are commonly prescribed to patients to prevent venous thromboembolism (VTE) – a serious condition in which a blood clot forms in a vein and could travel to the lung and impede the flow of blood. It is estimated that between 60,000 and 100,000 Americans die as a result of blood clot-related complications each year, according to the Centers for Disease Control and Prevention (CDC).

“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,” said Brandyn Lau, an assistant professor of surgery at the Johns Hopkins University School of Medicine.

Lau and colleagues created two online education programs aimed at teaching nurses about preventive measures for VTE, and giving them the tools to effectively communicate this information to the patients themselves. In all, over 900 nurses at The Johns Hopkins Hospital participated in the study, which was funded by the Patient-Centered Outcomes Research Institute (PCORI).

The static education module used a slide show and voiceover to convey the information to the nurses. In contrast, the dynamic module encouraged participation by presenting the learners with options for dealing with non-compliant patients.

The study coordinators tracked nonadministration rates for blood thinner medications before, during and after nurses underwent one of the two education interventions. The study took place over a one-year period, and nurses were randomly assigned to one of the two study arms.

“We teach in hopes of improving patient care, but there’s actually very little evidence that online professional education can have a measurable impact,” said Dr. Elliott Haut, associate professor and Vice Chair of Quality, Safety & Service, Department of Surgery, at the Johns Hopkins University School of Medicine. “Our results show that it does.”

Overall nonadministration rates among hospital staff who took part in the training were reduced from 12.4 percent to 11.1 percent. However, nurses who were trained using the dynamic education module showed a greater improvement in nonadministration rates, from 10.8 percent before the training to 9.2 percent afterwards. Those in the static education arm showed a reduction from 14.5 to 13.5.

“Our study adds to evidence that the way something is taught to professionals has a great influence on whether they retain information and apply it,” said Lau. “Active learning seems to get better results than passive learning, showing that it’s not just what you teach, but also howyou teach it.”

The study team hopes to make the training mandatory for all Johns Hopkins medical staff, as well as reach nurses working at other healthcare facilities across the country. “Now that we’ve shown the modules can be effective in improving practice, we want to make it available to the more than 3 million nurses practicing in the US,” said Haut.