Educating Nurses About Venous Thromboembolism (VTE) Prevention

Not Applicable

Completed

Conditions: Venous Thrombosis
Venous Thromboembolism

Interventions: Behavioral: Nurse education in traditional format
Behavioral: Nurse education in contemporary format

Registration Number: NCT02301793

Lead Sponsor: Johns Hopkins University

Brief Summary: As part of mandatory on-going nursing education, the investigators have incorporated identical information into two distinct web-based learning formats - the traditional linear PowerPoint format (with voice-over) and a new interactive format developed with central nursing education.

The investigators will cluster randomize nurses by floor to receive either the traditional education or the new interactive education, and evaluate the impact on administration of VTE prophylaxis doses administered by nurses before and after education. All nurses on a floor will receive the same educational format. If one method of education results in statistically significant improvement in VTE prophylaxis administration, the investigators will cross over to deliver the superior education format to all nurses who originally were given the less effective method.

Detailed Description: BACKGROUND

* In an attempt to improve venous thromboembolism (VTE) prophylaxis adherence the investigators carried out qualitative studies to obtain patients' viewpoints on how nurses should be educated about VTE prevention and to assess nurses' beliefs and perceptions about pharmacologic VTE prophylaxis

* The investigators observed deficiencies in nurses' knowledge and misconceptions about VTE prophylaxis that likely lowers adherence to administration of prescribed VTE prophylaxis doses

* As a part of our original Patient-Centered Outcomes Research Institute (PCORI) proposal, the investigators planned to educate nurses to address the observed deficiencies and misconceptions and improve their ability to communicate effectively with patients

* Historically, nurse education has been done via a linear, PowerPoint-based platform with voice-over but with no interactive component (TRADITIONAL)

* A newer platform for nurse education became available for use and includes scenario-based teaching, ongoing assessment, and immediate remediation. Most importantly, it is a highly interactive product (CONTEMPORARY)

STUDY DESIGN AND ANALYTIC PLAN

* Research hypotheses

* Primary: Nurse participants who receive either of these interventions will improve administration of prescribed VTE prophylaxis evidenced by a decrease in frequency of non-administered doses of VTE prophylaxis, compared with their frequency at baseline.

* Secondary: Nurse participants who receive the contemporary education format will have a larger decrease in frequency of missed doses of VTE prophylaxis compared with those who participate in the traditional education format.

* Study Design

* Cluster Randomized Trial 21 floors, block randomized by floor type (medicine \[n=11\] vs. surgery \[n=10\]) and (ICU \[n=5\] vs. non-ICU \[n=16\]) All nurses on each floor are assigned the same education type to mitigate issues related to contamination if nurses discuss the education with their colleagues

* Primary Outcome measure: Proportion of non-administered doses of pharmacological VTE prophylaxis (dose level)

* Secondary Outcome Measures:

* Proportion of doses documented as missed due to patient refusal (dose level)

* Proportion of patients with any VTE (patient level)

* Proportion of patients with Deep Vein Thrombosis (DVT) (patient level)

* Proportion of patients with Pulmonary Embolism (PE) (patient level)

* Analytic methods

* Primary analyses - Intention-to-treat (includes all nurses assigned, whether or not they completed the education) Is there a difference between units allocated to either of the interventions comparing their outcome measure to their baseline measure? Is there a difference comparing those who received the contemporary education format vs. the traditional education format?

* Secondary analysis - Per protocol (includes only nurses who completed the education) Do nurses who receive education perform better (improved administration of prescribed VTE prophylaxis) than those who did not? Do nurses who received the education in the contemporary format perform better than those who received it in the traditional format

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 933

Inclusion Criteria

Nurses on selected surgical and medical floors at Johns Hopkins Hospital

Exclusion Criteria

Nurses who were not permanently associated with one of the 21 hospital floors (e.g. traveling nurse, float nurse) were excluded from this study

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Traditional Education Format	Nurse education in traditional format	Nurses in this arm received education about venous thromboembolism (VTE) in a web-based traditional linear PowerPoint format with voice over. Intervention: Nurse education in traditional format
Contemporary Education Format	Nurse education in contemporary format	Nurses in this arm received education about venous thromboembolism (VTE) in a web-based contemporary interactive format. Intervention: Nurse education in contemporary format

Primary Outcome Measures

Name	Time	Method
Non Administration of Prescribed VTE Prophylaxis Medication Doses	(Baseline); approximately 3 months later (Post-Education)	This is the percentage of VTE prophylaxis doses that were not administered for any reason as documented in the electronic health record by a nurse

Secondary Outcome Measures

Name	Time	Method
Rates of All VTE Among Hospitalized Patients	3-12 months after end of study	Did the intervention decrease rates of VTE among hospitalized patients?
Rates of Pulmonary Embolism (PE) Among Hospitalized Patients	3-12 months after end of study	Did the intervention decrease rates of PE among hospitalized patients?
Rates of Deep Vein Thrombosis (DVT) Among Hospitalized Patients	3-12 months after end of study	Did the intervention decrease rates of DVT among hospitalized patients?
Proportion of Non Administration of Prescribed VTE Prophylaxis Medication Doses Which Are Documented as Patient Refusal	Baseline; approximately 3 months later (post education)	Did the intervention decrease rates of patient refusal of VTE prophylaxis medication doses among hospitalized patients?