{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:55:06Z","timestamp":1787018106290,"version":"build-2736575974"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,9,20]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Many hospitalized patients are not administered prescribed doses of pharmacologic venous thromboembolism prophylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In this cluster\u2010randomized controlled trial, all adult non\u2013intensive care units (10 medical, 6 surgical) in 1 academic hospital were randomized to either a real\u2010time, electronic alert\u2013triggered, patient\u2010centered education bundle intervention or nurse feedback intervention to evaluate their effectiveness for reducing nonadministration of venous thromboembolism prophylaxis. Primary outcome was the proportion of nonadministered doses of prescribed pharmacologic prophylaxis. Secondary outcomes were proportions of nonadministered doses stratified by nonadministration reasons (patient refusal, other). To test our primary hypothesis that both interventions would reduce nonadministration, we compared outcomes pre\u2010 versus postintervention within each cohort. Secondary hypotheses were tested comparing the effectiveness between cohorts. Of 11\u2009098 patient visits, overall dose nonadministration declined significantly after the interventions (13.4% versus 9.2%; odds ratio [OR], 0.64 [95% CI, 0.57\u20130.71]). Nonadministration decreased significantly (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) in both arms: patient\u2010centered education bundle, 12.2% versus 7.4% (OR, 0.56 [95% CI, 0.48\u20130.66]), and nurse feedback, 14.7% versus 11.2% (OR, 0.72 [95% CI, 0.62\u20130.84]). Patient refusal decreased significantly in both arms: patient\u2010centered education bundle, 7.3% versus 3.7% (OR, 0.46 [95% CI, 0.37\u20130.58]), and nurse feedback, 9.5% versus 7.1% (OR, 0.71 [95% CI, 0.59\u20130.86]). No differential effect occurred on medical versus surgical units. The patient\u2010centered education bundle was significantly more effective in reducing all nonadministered (\n                      <jats:italic>P<\/jats:italic>\n                      =0.03) and refused doses (\n                      <jats:italic>P<\/jats:italic>\n                      =0.003) compared with nurse feedback (OR, 1.28 [95% CI, 1.0\u20131.61];\n                      <jats:italic>P<\/jats:italic>\n                      =0.03 for interaction).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Information technology strategies like the alert\u2010triggered, targeted patient\u2010centered education bundle, and nurse\u2010focused audit and feedback can improve venous thromboembolism prophylaxis administration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03367364.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.122.027119","type":"journal-article","created":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T08:27:08Z","timestamp":1662020828000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Alert\u2010Triggered Patient Education Versus Nurse Feedback for Nonadministered Venous Thromboembolism Prophylaxis Doses: A Cluster\u2010Randomized Controlled Trial"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7075-771X","authenticated-orcid":false,"given":"Elliott R.","family":"Haut","sequence":"first","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore MD"},{"name":"Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD"},{"name":"Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore MD"},{"name":"The Johns Hopkins Surgery Center for Outcomes Research Johns Hopkins University School of Medicine Baltimore MD"},{"name":"Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwafemi P.","family":"Owodunni","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1715-3981","authenticated-orcid":false,"given":"Jiangxia","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dauryne L.","family":"Shaffer","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore MD"},{"name":"Department of Nursing The Johns Hopkins Hospital Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah B.","family":"Hobson","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore MD"},{"name":"Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD"},{"name":"Department of Nursing The Johns Hopkins Hospital Baltimore 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MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine L.","family":"Florecki","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen L.W.","family":"Webster","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine G.","family":"Holzmueller","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore MD"},{"name":"Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan K.","family":"Aboagye","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor O.","family":"Popoola","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD"},{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7689-6400","authenticated-orcid":false,"given":"Mujan Varasteh","family":"Kia","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Pronovost","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore MD"},{"name":"Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore 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