Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: A randomized clinical trial

Abstract

Background: Venous thromboembolism (VTE) is a common cause of preventable harm in hospitalized patients. While numerous successful interventions have been implemented to improve prescription of VTE prophylaxis, a substantial proportion of doses of prescribed preventive medications are not administered to hospitalized patients. The purpose of this trial was to evaluate the effectiveness of nurse education on medication administration practice.

Methods: This was a double-blinded, cluster randomized trial in 21 medical or surgical floors of 933 nurses at The Johns Hopkins Hospital, an academic medical center, from April 1, 2014 -March 31, 2015. Nurses were cluster-randomized by hospital floor to receive either a linear static education (Static) module with voiceover or an interactive learner-centric dynamic scenario-based education (Dynamic) module. The primary and secondary outcomes were non-administration of prescribed VTE prophylaxis medication and nurse-reported satisfaction with education modules, respectively.

Results: Overall, non-administration improved significantly following education (12.4% vs. 11.1%, conditional OR: 0.87, 95% CI: 0.80-0.95, p = 0.002) achieving our primary objective. The reduction in non-administration was greater for those randomized to the Dynamic arm (10.8% vs. 9.2%, conditional OR: 0.83, 95% CI: 0.72-0.95) versus the Static arm (14.5% vs. 13.5%, conditional OR: 0.92, 95% CI: 0.81-1.03), although the difference between arms was not statistically significant (p = 0.26). Satisfaction scores were significantly higher (p<0.05) for all survey items for nurses in the Dynamic arm.

Conclusions: Education for nurses significantly improves medication administration practice. Dynamic learner-centered education is more effective at engaging nurses. These findings suggest that education should be tailored to the learner.

Trial registration: ClinicalTrials.gov NCT02301793.

Conflict of interest statement

Competing Interests: Mr. Lau, Drs. Streiff and Haut are supported by a grant from the AHRQ (1R01HS024547) entitled “Individualized Performance Feedback on Venous Thromboembolism Prevention Practice,” a contract from PCORI entitled “Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis,” and a grant from the NIH/NHLBI (R21HL129028) entitled “Analysis of the Impact of Missed Doses of Venous Thromboembolism Prophylaxis.” Mr. Lau is supported by the Institute for Excellence in Education Berkheimer Faculty Education Scholar Grant and a contract (AD-1306-03980) from the Patient-Centered Outcomes Research Institute (PCORI) entitled “Patient Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the Emergency Department.” Ms. Hobson has given expert witness testimony in various medical malpractice cases. Dr. Pronovost reports consultancy fees from the Association for Professionals in Infection Control and Epidemiology, Inc., grant or contract support from the Agency for Healthcare Research & Quality, National Institutes of Health, Robert Wood Johnson Foundation, Patient Centered Outcomes Research Institute, and The Commonwealth Fund, honoraria from various hospitals and the Leigh Bureau (Somerville, NJ), and royalties from his book, Safe Patients Smart Hospitals. Dr. Streiff has received research funding from Portola and Janssen, consulted for Bio2Medical, CSL Behring, Merck and Janssen HealthCare and has given expert witness testimony in various medical malpractice cases. Dr. Haut is a paid consultant and speaker for the “Preventing Avoidable Venous Thromboembolism— Every Patient, Every Time” VHA/Vizient IMPERATIV® Advantage Performance Improvement Collaborative. Dr. Haut receives royalties from Lippincott, Williams, Wilkins for a book - "Avoiding Common ICU Errors." Dr. Haut is a paid consultant and speaker for the Illinois Surgical Quality Improvement Collaborative "ISQIC." Dr. Haut was the paid author of a paper commissioned by the National Academies of Medicine titled “Military Trauma Care’s Learning Health System: The Importance of Data Driven Decision Making” which was used to support the report titled “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.” This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors report no disclosures.

Figures

Fig 1. Flow of nurse participants through trial comparing Dynamic education with static education on medication administration practice for venous thromboembolism prevention.

Fig 2. Nurse-reported satisfaction with and perception of Dynamic education module and the Static education module across five domains of engagement among nurses who completed their assigned education module.