Clinical trial NCT03771482: Education of Providers on Prescribing Best Practices
Official title: Education of Providers on Prescribing Best Practices
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Education
Lead sponsor: Vanderbilt University Medical Center
Sponsor class: OTHER
First posted: 2018-12-11
Enrollment: 369
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

Eligibility criteria: Inclusion Criteria:

* All inpatient prescribing providers

Exclusion Criteria:

* none

Primary outcomes:
measure: Median morphine milligram equivalents (MME) per opioid prescription
timeFrame: 8 months
measure: Percentage of orders for balanced intravenous (IV) fluid solutions (i.e. not normal saline)
timeFrame: 8 months
Secondary outcomes:
measure: Chloride levels in patients receiving intravenous fluid orders from a provider enrolled in the study
timeFrame: 8 months
measure: Potassium levels in patients receiving intravenous fluid orders from a provider enrolled in the study
timeFrame: 8 months
measure: Major Adverse Kidney Events by 30 days (MAKE 30) in patients receiving intravenous fluid orders from a provider enrolled in the study
timeFrame: 30 days
measure: Length of stay for patients receiving an intravenous fluid order or an opioid prescription from a provider enrolled in the study.
timeFrame: 8 months
measure: 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
timeFrame: 8 months
measure: Median number of pills per prescription for patients receiving an opioid prescription from a provider enrolled in the study
timeFrame: 8 months
measure: 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.)
timeFrame: 8 months
measure: Percent of opioid prescriptions (discharge) that also had a scheduled (not PRN) non-opioid (APAP, NSAIDs, GABA, muscle relaxant, etc.)
timeFrame: 8 months
measure: 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)
timeFrame: 8 months
Other outcomes:
Locations:
city: Nashville
country: United States
facility: Vanderbilt University Medical Center
state: Tennessee
Study officials:
affiliation: Vanderbilt University Medical Center
name: Matthew McEvoy, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: McEvoy MD, Dear ML, Buie R, Edwards DA, Barrett TW, Allen B, Robertson AC, Fowler LC, Hennessy C, Miller BM, Garvey KV, Bland RP 3rd, Fleming GM, Moore D, Rice TW, Bernard GR, Lindsell CJ; Vanderbilt Learning Healthcare System Platform Investigators and the Vanderbilt Committee on Opioid Monitoring and Stewardship. Effect of Smartphone App-Based Education on Clinician Prescribing Habits in a Learning Health Care System: A Randomized Cluster Crossover Trial. JAMA Netw Open. 2022 Jul 1;5(7):e2223099. doi: 10.1001/jamanetworkopen.2022.23099.
citation: McEvoy MD, Dear ML, Buie R, Fowler LC, Miller B, Fleming GM, Moore D, Rice TW, Bernard GR, Lindsell CJ; Vanderbilt Learning Healthcare System Investigators. Embedding Learning in a Learning Health Care System to Improve Clinical Practice. Acad Med. 2021 Sep 1;96(9):1311-1314. doi: 10.1097/ACM.0000000000003969.