One in Ten Patients not Getting Blood-Thinners
More than one in 10 hospitalized patients don’t receive blood thinners ordered by their doctors to prevent potentially serious blood clots, according to a recent study. Researchers report the problem may be related to misguided concern about the safety and necessity of blood thinners by patients and caregivers.
Researchers call the rate of missed doses “unacceptably high”.
They and add that hospitalized patients are at a far greater risk of developing blood clots, or venous thromboembolism (VTE), which can be prevented most of the time by blood thinners.
“There appeared to be a lack of understanding about the risks and benefits of blood thinners among patients and medical staff, even though the research is clear that blood thinners are very effective at preventing blood clots,” says Kenneth M. Shermock, Pharm.D., Ph.D., the director of the Center for Medication Quality and Outcomes at The Johns Hopkins Hospital, and leader of the study. “Blood clots and their resulting effects are the most common cause of avoidable death for hospitalized patients and we’ve got a medication that can prevent most of these events. But too many patients are not benefiting.”
12 Percent of Patients not Getting Drug
The study found that 12 percent of ordered doses of blood thinner were not given to patients, with the most commonly noted reason being patient or family-member refusal (59 percent). Another problem was that patients were sometimes away from their rooms getting tests or in surgery when the scheduled doses of the drug were to be given.
Other research done by Shermock suggests that in some cases, nurses may have implied to patients that blood thinners are optional. But Shermock says it’s important to understand the reasons behind this finding and to provide more education to nurses emphasizing the proven benefits of blood thinners for hospitalized patients.
For the study, researchers analyzed more than 103,000 VTE “prophylaxis” (preventive) doses of a blood thinner called “unfractionated heparin” (also known as “enoxaparin“) ordered for more than 10,500 patients between 2007 and 2008. Patients from 29 floors were included in the analysis: 11 medicine floors, nine surgery floors, four neurology floors and five intensive care units.
Some Floors Have Lower Compliance
The authors found that some floors of the hospital had much lower compliance rates. Nurses on medicine floors were least likely to recommend blood thinners to patients, which is where 25 to 30 percent of doses were not given. Shermock says “education programs specifically targeted to these areas known could improve their use at a lower cost than educating the whole hospital”.
The study did show that almost 60 percent of patients received all of their ordered doses. Roughly 20 percent of patients accounted for 80 percent of missed doses, with 20 percent of patients missing at least a quarter of their doses and 10 percent missing more than half of their doses, he says.
Focusing specifically on those patients who have missed doses could make a big impact, he says. The electronic medical record could be of help with that, showing in real time which patients have refused their medication and thus lead to the staging of an immediate intervention. “We want to be able to get to these patients before there is an adverse event such as a blood clot”, he says.
Sometimes patients refused the shots because of the pain and bruising associated with them. So the researchers are starting a pilot program to test a new less-painful type of injection.