Education of Providers on Prescribing Best Practices

Not Applicable

Completed

• Conditions: Education
• Interventions: Behavioral: Quiztime modules

• Registration Number: NCT03771482
• Lead Sponsor: Vanderbilt University Medical Center

Brief Summary

This study aims to evaluate the impact of spaced education, delivered via a smartphone application, on provider prescribing patterns.

Detailed Description

As part of a medical center educational initiative at Vanderbilt University Medical Center (VUMC), two educational modules will be sent to prescribing providers through either email or short message service (SMS) text messaging. The first educational module consists of a set of multiple choice questions concerning best practices for prescribing intravenous fluids in the inpatient and perioperative setting. This module is based upon recent literature and specifically derived from the results of the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) and Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED) trial, both published in the New England Journal of Medicine in 2018 and led by Vanderbilt investigators. Similarly, a second educational module concerning evidence-based pain management and opioid prescribing practices will be distributed via email or SMS text messaging.

Participants will receive one question per day. If the participant does not answer the question correctly, they will receive the opportunity to attempt the question again after reviewing evidence-based education. All questions have been curated and reviewed by a panel of experts and piloted within VUMC for feasibility and acceptability. Key concepts are repeated in each module and questions are strategically ordered throughout each module to accomplish spaced education.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2018-12-07
• Study First Submitted QC: 2018-12-07
• Study First Posted: 2018-12-11
• Study Start: 2019-12-30
• Primary Completion: 2020-06-15
• Study Completion: 2020-06-15
• Status Verified: 2020-10
• Last Update Submitted: 2020-10-13
• Last Update Posted: 2020-10-14

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 369

Inclusion Criteria

• All inpatient prescribing providers

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Exclusion Criteria

• none

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Fluid module first then opioid	Quiztime modules	The providers in this arm will first receive daily information and questions related to intravenous fluid prescribing for five weeks and then daily information and questions related to opioid use for eight weeks.
Opioid module first then fluid	Quiztime modules	The providers in this arm will first receive daily information and questions related to opioid use for eight weeks and then daily information and questions related to intravenous fluid prescribing for five weeks.

Primary Outcome Measures

Name	Time	Method
Median morphine milligram equivalents (MME) per opioid prescription	8 months	By extracting prescribing data for opioids from the electronic health records
Percentage of orders for balanced intravenous (IV) fluid solutions (i.e. not normal saline)	8 months	By extracting prescribing data for intravenous fluids from the electronic health records

Secondary Outcome Measures

Name	Time	Method
Length of stay for patients receiving an intravenous fluid order or an opioid prescription from a provider enrolled in the study.	8 months	By extracting length of stay data from the electronic health records
Potassium levels in patients receiving intravenous fluid orders from a provider enrolled in the study	8 months	By extracting potassium level data from the electronic health records
Major Adverse Kidney Events by 30 days (MAKE 30) in patients receiving intravenous fluid orders from a provider enrolled in the study	30 days	By extracting data from the electronic health records
Percent of opioid prescriptions (inpatient) that also had a scheduled (not pro re nata (PRN)) non-opioid (APAP, nonsteroidal anti-inflammatory drugs (NSAIDs), gamma-Aminobutyric acid (GABA), muscle relaxant, etc.)	8 months	By extracting medication data from the electronic health records
Number of Rapid Response Team calls (RRT s) indexed to the number of patients cared for per prescriber (evaluated by level of engagement of the learner with QuizTime)	8 months	By extracting RRT calls from the electronic health records
Chloride levels in patients receiving intravenous fluid orders from a provider enrolled in the study	8 months	By extracting chloride level data from the electronic health records
Median number of pills per prescription for patients receiving an opioid prescription from a provider enrolled in the study	8 months	By extracting medication data from the electronic health records
Length of stay in the intensive care unit (ICU) for patients receiving an intravenous fluid order or an opioid prescription from a provider enrolled in the study	8 months	By extracting ICU length of stay from the electronic health records
Percent of opioid prescriptions (discharge) that also had a scheduled (not PRN) non-opioid (APAP, NSAIDs, GABA, muscle relaxant, etc.)	8 months	By extracting medication data from the electronic health records

Trial Locations

Locations (1)

Vanderbilt University Medical Center; 🇺🇸 Nashville, Tennessee, United States