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

Abstract

BackgroundVenous 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.MethodsThis 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.ResultsOverall, 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.ConclusionsEducation 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 registrationClinicalTrials.gov NCT02301793

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“…Cluster randomized trials might randomize at the floor, unit, clinic, or hospital level. For example, a cluster randomized trial examining the effectiveness of nurse education to improve venous thromboembolism prevention in hospitalized patients randomly assigned 21 floors within a hospital to one of two educational interventions 31. The benefits of cluster randomization may include the ability to study interventions that cannot be given to only selected patients (such as nurse education), and the ability to prevent contamination between individuals (ie, all nurses working together on the same floor receive the same intervention).…”

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“…In one report, the compliance rate of patients with guidance from nurses was 85%, while the compliance rate of patients without guidance was 55%. 24 Therefore, all medical staff need to fully understand why a patient needs to wear a portable IPCD for VTE prophylaxis. By doing so, all medical staff can provide proper guidance to patients regarding the wearing method of the portable IPCD, which might consequently improve compliance with VTE prophylaxis and thus reduce the incidence of VTE.…”

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“…In the United States, VTE affects 350,000 to 600,000 individuals every year and more than 100,000 individuals die annually. [4] Previous studies considered VTE as a rare disease in Asia. [5,6] However, many recent studies found that the incidence of VTE was not as low as previously thought, on the contrary, incidence of VTE may be increasing in recent years.…”