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Venous Thrombosis (Disorder)ENACTNCT03367364

Patient Education Bundle vs. Nurses Feedback and Coaching to Prevent Missed Doses of VTE Prophylaxis

A study testing Patient education bundle (PEB), and Nurse feedback and coaching (NFC) in people with Venous Thrombosis (Disorder), run by Johns Hopkins University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

VTE associated harm is underappreciated among hospitalized patients and may be associated with missed doses of VTE prophylaxis medications. In order to ensure best practices, and administer a defect-free VTE prevention nurses must understand and educate patients on the importance of the VTE prophylaxis. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Venous Thrombosis (Disorder)
What is being tested?
Patient education bundle (PEB), and Nurse feedback and coaching (NFC)
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
9,657 participants
Where
1 siteUnited States
Study dates
1 Jan 2018to 1 Nov 2018
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult
  1. Eligible floors are defined as:
  2. All medical and surgical floors (non- intensive care units) B. 16 total floors (10 medicine, 6 surgery)
  3. Eligible Patients are defined as: All patients on assigned floors except:
  4. Patient data for those transferred between floors will be excluded. B. Patient data for those on floors during the cross-over time will be excluded.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Johns Hopkins Medical Institutions

    Baltimore, Maryland, 21287

Other trials in United States

About this study

Official title: Patient Education Bundle vs. Nurses Feedback and Coaching to Prevent Missed Doses of Venous Thromboembolism (VTE) Prophylaxis: A Crossover, Cluster Randomized Controlled Trial

VTE associated harm is underappreciated among hospitalized patients and may be associated with missed doses of VTE prophylaxis medications. In order to ensure best practices, and administer a defect-free VTE prevention nurses must understand and educate patients on the importance of the VTE prophylaxis. We propose to conduct a randomized trial comparing the effect of a validated, real-time patient education bundle (PEB), to a program of nurse feedback and coaching (NFC) provided by nurse leaders.

Read the detailed description

Missed doses of prescribed Venous Thromboembolism (VTE) pharmacologic prophylaxis is a significant problem. Data on patients admitted to The Johns Hopkins Hospital found approximately 12% of prescribed doses of pharmacologic VTE prophylaxis were not administered. There were several reasons for these missed doses. The leading reason (nearly 60% of missed doses) was patient or family member refusal for any reason.

Based on data collected by the Maryland Health Services Cost Review Commission (HSCRC) in the Maryland hospital-acquired conditions (MHAC) program, during 2011 half of patients who developed confirmed VTE at The Johns Hopkins Hospital were not administered one or more doses of prescribed VTE prophylaxis. These data indicate that missed or refused doses of VTE prophylaxis represent a significant and under-recognized contributor to sub-optimal VTE prophylaxis that will erode the beneficial impact of current efforts to improve rates of VTE prophylaxis ordering by physicians.

As part of a Patient-Centered Outcomes Research Institute (PCORI)-funded project, the investigators have developed a registry of missed doses of VTE prophylaxis that includes data on missed doses of VTE prophylaxis.

Primary hypothesis Both interventions (PEB and NFC) will improve medication administration (as measured by missed doses)

Secondary hypotheses

  1. Combining both interventions (PEB and NFC) will decrease patient refusal of VTE prophylaxis
  2. Combining both interventions (PEB and NFC) will decrease missed doses for reasons other than patient refusal
  3. Overall, PEB intervention will be more effective than NFC in reducing missed doses for any reason:
  4. The PEB intervention will be more effective than NFC in reducing in reducing patient refusal
  5. The NFC intervention will be more effective than PEB in reducing missed doses for other reasons of missed doses other than patient refusal
  6. There will be a differential effect on medicine and surgery floors
  7. There will be a differential effect by patient level characteristics (race, age, sex)
  8. There will be a differential effect on high vs. low performing floors
  9. There will be a differential effect dependent on pharmacological dosing regimen (i.e. medication, frequency)
  10. There will be an overall decline in the incidence of VTE events (all, DVT, PE)

Design A single institution, crossover, cluster randomized controlled trial (x-cRCT).

Intervention

In the PEB arm, the intervention will include:

A charge nurse will intervene in real-time via an EHR-triggered alert when there is documentation that a dose of VTE prophylaxis medication is not given for any reason. The charge nurse will speak to the bedside nurse and one of them will provide the patient with the education bundle including one-on-one personalized discussion, supplemented by a 2-page paper handout and patient education video.

In the NFC arm, the intervention will include:

Nurse leadership (i.e. managers, directors) will provide data to all nurses on their personal clinical effectiveness with the proportion of doses of VTE prophylaxis administered. The data will have comparisons to their nurse peers on the same floor. Coaching for nurses will include one-on-one conversations with bedside nurses with lower performance than their peers.

Being tested
Patient education bundle (PEB),, Nurse feedback and coaching (NFC)
Keywords
Venous Thromboembolism, Deep Venous Thrombosis, Clots
Medical subject headings
Venous Thrombosis, Venous Thromboembolism

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Patient education bundle (PEB),Behavioural

    A charge nurse will intervene in real-time via an EHR-triggered alert when there is documentation that a dose of VTE prophylaxis medication is not given for any reason. The charge nurse will speak to the bedside nurse and one of them will provide the patient with the education bundle including one-on-one personalized discussion, supplemented by a 2-page paper handout and patient education video.

  • Nurse feedback and coaching (NFC)Behavioural

    Nurse leadership (i.e. managers, directors) will provide data to all nurses on their personal clinical effectiveness with the proportion of doses of VTE prophylaxis administered. The data will have comparisons to their nurse peers on the same floor. Coaching for nurses will include one-on-one conversations with bedside nurses with lower performance than their peers.

Study groups in NCT03367364
Study groupRoleWhat they receive
Patient education bundle (PEB)Active comparatorA charge nurse will intervene in real-time via an EHR-triggered alert when there is documentation that a dose of VTE prophylaxis medication is not given for any reason. The charge nurse will speak to the bedside nurse and one of them will provide the patient with the education bundle including one-on-one personalized discussion, supplemented by a 2-page paper handout and patient education video.
Receives: Behavioral: Patient education bundle (PEB),
Nurse feedback and coaching (NFC)Placebo comparatorNurse leadership (i.e. managers, directors) will provide data to all nurses on their personal clinical effectiveness with the proportion of doses of VTE prophylaxis administered. The data will have comparisons to their nurse peers on the same floor. Coaching for nurses will include one-on-one conversations with bedside nurses with lower performance than their peers.
Receives: Behavioral: Nurse feedback and coaching (NFC)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Missed doses of VTE prophylaxis

    Proportion of VTE prophylaxis doses not administered

    Measured: 1 year

Secondary outcomes (5)
  1. Patient refused doses of VTE prophylaxis

    Proportion of VTE prophylaxis doses not administered due to patient/family refusal

    Measured: 1 year

  2. Missed doses of VTE prophylaxis for reasons other than patient refusal

    Proportion of VTE prophylaxis doses not administered due to reasons other than patient/family refusal

    Measured: 1 year

  3. VTE events (all VTE, DVT, PE)

    Proportion of VTE events recorded

    Measured: 1 year

  4. Patient satisfaction

    surveys and HCAHPS scores

    Measured: 1 year

  5. Nurse Satisfaction

    surveys

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Dec 2017
  2. Study start1 Jan 2018
  3. Primary completion1 Nov 2018
  4. Study completion1 Nov 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
In the PEB arm, the intervention will include: A charge nurse will intervene in real-time via an EHR-triggered alert when there is documentation that a dose of VTE prophylaxis medication is not given for any reason. The charge nurse will speak to the bedside nurse and one of them will provide the patient with the education bundle including one-on-one personalized discussion, supplemented by a 2-page paper handout and patient education video. In the NFC arm, the intervention will include: Nurse leadership (i.e. managers, directors) will provide data to all nurses on their personal clinical effectiveness with the proportion of doses of VTE prophylaxis administered. The data will have comparisons to their nurse peers on the same floor. Coaching for nurses will include one-on-one conversations with bedside nurses with lower performance than their peers.
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
9,657 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03367364
Sponsor's protocol ID
IRB00157201
Other IDs
DI-1603-34596
Acronym
ENACT
Status last verified
Dec 2021
First submitted
5 Dec 2017
Last updated
2 Mar 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Lau BD, Shaffer DL, Hobson DB, Yenokyan G, Wang J, Sugar EA, Canner JK, Bongiovanni D, Kraus PS, Popoola VO, Shihab HM, Farrow NE, Aboagye JK, Pronovost PJ, Streiff MB, Haut ER. Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: A randomized clinical trial. PLoS One. 2017 Aug 16;12(8):e0181664. doi: 10.1371/journal.pone.0181664. eCollection 2017.

    PubMed 28813425
  • Lau BD, Streiff MB, Kraus PS, Hobson DB, Shaffer DL, Aboagye JK, Pronovost PJ, Haut ER. Missed Doses of Venous Thromboembolism (VTE) Prophylaxis at Community Hospitals: Cause for Alarm. J Gen Intern Med. 2018 Jan;33(1):19-20. doi: 10.1007/s11606-017-4203-y. No abstract available.

    PubMed 29043537
  • Streiff MB, Carolan HT, Hobson DB, Kraus PS, Holzmueller CG, Demski R, Lau BD, Biscup-Horn P, Pronovost PJ, Haut ER. Lessons from the Johns Hopkins Multi-Disciplinary Venous Thromboembolism (VTE) Prevention Collaborative. BMJ. 2012 Jun 19;344:e3935. doi: 10.1136/bmj.e3935.

    PubMed 22718994
  • Shermock KM, Lau BD, Haut ER, Hobson DB, Ganetsky VS, Kraus PS, Efird LE, Lehmann CU, Pinto BL, Ross PA, Streiff MB. Patterns of non-administration of ordered doses of venous thromboembolism prophylaxis: implications for novel intervention strategies. PLoS One. 2013 Jun 14;8(6):e66311. doi: 10.1371/journal.pone.0066311. Print 2013.

    PubMed 23799091
  • Haut ER, Lau BD, Kraus PS, Hobson DB, Maheshwari B, Pronovost PJ, Streiff MB. Preventability of Hospital-Acquired Venous Thromboembolism. JAMA Surg. 2015 Sep;150(9):912-5. doi: 10.1001/jamasurg.2015.1340. No abstract available.

    PubMed 26222738
  • Streiff MB, Lau BD, Hobson DB, Kraus PS, Shermock KM, Shaffer DL, Popoola VO, Aboagye JK, Farrow NA, Horn PJ, Shihab HM, Pronovost PJ, Haut ER. The Johns Hopkins Venous Thromboembolism Collaborative: Multidisciplinary team approach to achieve perfect prophylaxis. J Hosp Med. 2016 Dec;11 Suppl 2:S8-S14. doi: 10.1002/jhm.2657.

    PubMed 27925423
  • Haut ER, Owodunni OP, Wang J, Shaffer DL, Hobson DB, Yenokyan G, Kraus PS, Farrow NE, Canner JK, Florecki KL, Webster KLW, Holzmueller CG, Aboagye JK, Popoola VO, Kia MV, Pronovost PJ, Streiff MB, Lau BD. Alert-Triggered Patient Education Versus Nurse Feedback for Nonadministered Venous Thromboembolism Prophylaxis Doses: A Cluster-Randomized Controlled Trial. J Am Heart Assoc. 2022 Sep 20;11(18):e027119. doi: 10.1161/JAHA.122.027119. Epub 2022 Sep 1.

    PubMed 36047732

Questions about this trial

What is this clinical trial studying?

A study testing Patient education bundle (PEB), and Nurse feedback and coaching (NFC) in people with Venous Thrombosis (Disorder), run by Johns Hopkins University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 2 Mar 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Missed doses of VTE prophylaxis (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03367364, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Mar 2023.

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