Education of Providers on Prescribing Best Practices

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

Detailed Description
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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.

Official Title
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Education of Providers on Prescribing Best Practices

Conditions
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Education

Intervention / Treatment
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* Behavioral: Quiztime modules


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All inpatient prescribing providers Exclusion Criteria: none

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Opioid module first then fluid<br>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. | Behavioral: Quiztime modules<br>* Text Messaging or Email system<br>|
| Active Comparator: Fluid module first then opioid<br>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. | Behavioral: Quiztime modules<br>* Text Messaging or Email system<br>|

What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Chloride levels in patients receiving intravenous fluid orders from a provider enrolled in the study | By extracting chloride level data from the electronic health records | 8 months | 
| Potassium levels in patients receiving intravenous fluid orders from a provider enrolled in the study | By extracting potassium level data from the electronic health records | 8 months | 
| Major Adverse Kidney Events by 30 days (MAKE 30) in patients receiving intravenous fluid orders from a provider enrolled in the study | By extracting data from the electronic health records | 30 days | 
| Length of stay for patients receiving an intravenous fluid order or an opioid prescription from a provider enrolled in the study. | By extracting length of stay data from the electronic health records | 8 months | 
| 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 | By extracting ICU length of stay from the electronic health records | 8 months | 
| Median number of pills per prescription for patients receiving an opioid prescription from a provider enrolled in the study | By extracting medication data from the electronic health records | 8 months | 
| 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.) | By extracting medication data from the electronic health records | 8 months | 
| Percent of opioid prescriptions (discharge) that also had a scheduled (not PRN) non-opioid (APAP, NSAIDs, GABA, muscle relaxant, etc.) | By extracting medication data from the electronic health records | 8 months | 
| 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) | By extracting RRT calls from the electronic health records | 8 months |