L. J. Kreutzer3, A. D. Yang2,3, D. B. Hewitt3,4, K. Y. Bilimoria2,3, J. K. Johnson2,3 2Feinberg School Of Medicine – Northwestern University,Center For Healthcare Studies In The Institute For Public Health And Medicine,Chicago, IL, USA 3Feinberg School Of Medicine – Northwestern University,Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 4Thomas Jefferson University,Surgery,Philadelphia, PA, USA
Introduction: Venous thromboembolism (VTE) is the leading cause of preventable inpatient death. VTE prophylaxis for moderate to high risk patients includes chemoprophylaxis; however, patients who refuse prophylaxis increase their VTE risk. Studies suggest that nurses can influence patient compliance with VTE prophylaxis. We previously conducted nursing focus groups at one hospital and found that they felt ill-equipped to handle patient refusals of VTE chemoprophylaxis. Our objective was to assess the effectiveness of a structured simulation session designed to equip nurses with skills to handle conversations with patients refusing VTE chemoprophylaxis.
Methods: Based on the findings from our qualitative study, we developed a 20-minute interactive in-person patient VTE chemoprophylaxis refusal simulation (Figure) as part of a larger VTE Prophylaxis Improvement Bundle. The simulation session goals were to 1) discuss the perspective of inpatients who refuse VTE chemoprophylaxis, 2) equip nurses with strategies to address patient refusals, 3) provide opportunities for nurses to learn from each other, and 4) to practice the nurse-patient conversation around VTE chemoprophylaxis refusal. After a brief brainstorming session discussing reasons why patients refuse VTE prophylaxis, nurse participants role-played as both the nurse and patient in a scenario where a patient refuses VTE chemoprophylaxis. The facilitators then debriefed the entire group of nurses to discuss effective strategies to respond to patient concerns. Participants then switched roles and repeated the role-play. Nurses received a reference sheet on effective strategies to respond to patients who decline VTE prophylaxis. We evaluated nurses’ perceptions of the utility and effectiveness of the experience with a post-session survey.
Results:We conducted 17 patient refusal simulation sessions including a total of 122 nurses from 4 inpatient units. After the simulation session, 98.4% of nurses felt ‘Quite a Bit’ or ‘A Great Deal’ able to speak with patients refusing VTE chemoprophylaxis compared to 76.2% pre-intervention (P<0.001). Furthermore, 94% of nurses intended to change their practice as a result of the session. Attendees translated lessons learned as they returned to their units: “After the session, I saw a lot more confidence when nurses were explaining the benefits of the medication to help prevent VTE.” – Unit Nurse Manager
Conclusion:A brief, focused interactive simulation session met an educational need and improved nurses’ ability to discuss VTE prophylaxis with patients. Future efforts will focus on expanding the initiative across our hospital system by integrating the sessions into the nursing education curriculum.
