Impact of an Asynchronous Spaced Education Learning Intervention on Emergency Medicine Clinician Opioid Prescribing

Barrett, Tyler W.; McEvoy, Matt D; Fowler, Leslie C; Shotwell, Matthew S.; Shi, Yaping; Costello, Michael; Rogers, Devin; Slayton, Jennifer M.; Edwards, David A.

doi:10.7759/cureus.18165

Cited by 4 publications

(7 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, this approach promotes high learner engagement with sustained knowledge acquisition. 17 Although additional education remains an important opportunity to increase nursing participation in AMS, another major barrier is prescriber pushback and challenges with interdisciplinary communication. 23 One participant in our study stated, "Nurses are not the ones deciding on when to start antibiotics or which [antibiotics] to use.…”

Section: Discussionmentioning

confidence: 99%

“…Also, we did not assess whether our intervention led to meaningful changes in clinical practice, though research has previously demonstrated changes in clinical practice following spaced education interventions. [24][25][26][27] In this pilot study, we focused on the implementation and utility of the QuizTime platform for AMS education. Future efforts could focus on improving participation, assessing long-term impact, and scaling similar interventions to a broader population.…”

Section: Discussionmentioning

confidence: 99%

“…Shorter and more targeted learning material is more easily processed and better retained than traditional longer formats. 17 Microlearning has been shown to improve performance among students in health professions. 18 However, this novel pedagogical approach has not been applied in nursing AMS education.…”

mentioning

confidence: 99%

See 2 more Smart Citations

An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform

Bobbitt

Cimino²,

Garvey³

et al. 2023

ASHE

View full text Add to dashboard Cite

Background: Nurses perform several functions that are integral for antimicrobial stewardship (AMS). However, nurses are underrepresented in research and underutilized in implementation of AMS interventions. The objective of this pilot study was to assess the effect of asynchronous microlearning on inpatient nursing staff knowledge, attitudes, and practices (KAP) regarding AMS principles. Methods: A team of pharmacists, physicians, and nurses developed 9 case-based, multiple-choice questions with accompanying educational explanations on associated AMS principles. One case was delivered to participants daily via an institutional web-based application (QuizTime). A KAP survey with 20 questions on a 5-point Likert scale was administered before and after the intervention. Survey results were compared using a Wilcoxon signed-rank test. Results: Participants’ mean survey score after the intervention demonstrated statistically significant improvement for 18 (90%) of 20 items compared to before the intervention. Participants’ confidence improved in key AMS activities: (1) differentiating between colonization and infection (mean difference, 0.63; P < .001), (2) identifying unnecessary urine cultures and inappropriate treatment of urinary tract infections (mean difference, 0.94; P < .001), (3) recognizing opportunities for intravenous to oral therapy conversion (mean difference, 1.07; P < .001), and (4) assessing for antibiotic-associated adverse effects (mean difference, 0.54; P < .001). Conclusions: Nursing education provided through an asynchronous, microlearning format via a mobile platform resulted in statistically significant improvement in most KAP topics. Nurses are integral members of a multidisciplinary AMS team, and novel education methods can help equip them with the necessary AMS tools. This pilot study forms the basis for expanded AMS educational efforts in all healthcare professionals.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform

Bobbitt

Cimino²,

Garvey³

et al. 2023

ASHE

View full text Add to dashboard Cite

show abstract

“…The link between spaced education through multiple-choice questions and improvements in clinical performance is not new. Shaw et al 6 demonstrated that primary care clinicians who received spaced education self-reported substantially more clinical practice change than those who received only standard didactics, and Barrett et al 28 showed a change among emergency department clinicians who received training with QuizTime. Kerfoot et al 19 reported that spaced education improved clinical behaviors related to prostate cancer screening in a trial of 95 primary care clinicians.…”

Section: Discussionmentioning

confidence: 99%

“… 11 The combination of spaced education and retrieval practice can be better than traditional pedagogical approaches for clinicians, with evidence suggesting improved knowledge acquisition, knowledge retention, and, in some cases, clinical practice. 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 The combination of spaced education and retrieval practice also has the potential for deployment at the institutional level for large learner groups. Whether spaced education with retrieval practice can change prescribing patterns at the institutional level is unknown.…”

Section: Introductionmentioning

confidence: 99%

Effect of Smartphone App–Based Education on Clinician Prescribing Habits in a Learning Health Care System

et al. 2022

Self Cite

View full text Add to dashboard Cite

IMPORTANCEEffective methods for engaging clinicians in continuing education for learning-based practice improvement remain unknown. OBJECTIVE To determine whether a smartphone-based app using spaced education with retrieval practice is an effective method to increase evidence-based practice. DESIGN, SETTING, AND PARTICIPANTSA prospective, unblinded, single-center, crossover randomized clinical trial was conducted at a single academic medical center from January 6 to April 24, 2020. Vanderbilt University Medical Center clinicians prescribing intravenous fluids were invited to participate in this study. INTERVENTIONSAll clinicians received two 4-week education modules: 1 on prescribing intravenous fluids and 1 on prescribing opioid and nonopioid medications (counterbalancing measure), over a 12-week period. The order of delivery was randomized 1:1 such that 1 group received the fluid management module first, followed by the pain management module after a 4-week break, and the other group received the pain management module first, followed by the fluid management module after a 4-week break. MAIN OUTCOMES AND MEASURESThe primary outcome was evidence-based clinician prescribing behavior concerning intravenous fluids in the inpatient setting and pain medication prescribing on discharge from the hospital. RESULTS A total of 354 participants were enrolled and randomized, with 177 in group 1 (fluid then pain management education) and 177 in group 2 (pain management then fluid education). During the overall study period, 16 868 questions were sent to 349 learners, with 11 783 (70.0%) being opened: 10 885 (92.4%) of those opened were answered and 7175 (65.9%) of those answered were answered correctly. The differences between groups changed significantly over time, indicated by the significant interaction between educational intervention and time (P = .002). Briefly, at baseline evidence-concordant IV fluid ordered 7.2% less frequently in group 1 than group 2 (95% CI, −19.2% to 4.9%). This was reversed after training at 4% higher (95% CI, −8.2% to 16.0%) in group 1 than group 2, a more than doubling in the odds of evidence-concordant ordering (OR, 2.56, 95% CI, 0.80-8.21). Postintervention, all gains had been reversed with less frequent ordering in group 1 than group 2 (−9.5%, 95% CI, −21.6% to 2.7%). There was no measurable change in opioid prescribing behaviors at any time point.

show abstract

Improving Neuromuscular Monitoring Through Education-Based Interventions and Studying Its Association With Adverse Postoperative Outcomes: A Retrospective Observational Study

Carr,

Clifton,

Freundlich

et al. 2024

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND: We assessed the association between education-based interventions, the frequency of train-of-four (TOF) monitoring, and postoperative outcomes. METHODS: We studied adults undergoing noncardiac surgery from February 1, 2020 through October 31, 2021. Our education-based interventions consisted of 3 phases. An interrupted time-series analysis, adjusting for patient- and procedure-related characteristics and secular trends over time, was used to assess the associations between education-based interventions and the frequency of TOF monitoring, postoperative pulmonary complications (PPCs), 90-day mortality, and sugammadex dosage. For each outcome and intervention phase, we tested whether the intervention at that phase was associated with an immediate change in the outcome or its trend (weekly rate of change) over time. In a sensitivity analysis, the association between education-based interventions and postoperative outcomes was adjusted for TOF monitoring. RESULTS: Of 19,422 cases, 11,636 (59.9%) had documented TOF monitoring. Monitoring frequency increased from 44.2% in the first week of preintervention stage to 83.4% in the final week of the postintervention phase. During the preintervention phase, the odds of TOF monitoring trended upward by 0.5% per week (odds ratio [OR], 1.005; 95% confidence interval [CI], 1.002–1.007). Phase 1 saw an immediate 54% increase (OR, 1.54; 95% CI, 1.33–1.79) in the odds, and the trend OR increased by 3% (OR, 1.03; 95% CI, 1.01–1.05) to 1.035, or 3.5% per week (joint Wald test, P < .001). Phase 2 was associated with a further immediate 29% increase (OR, 1.29; 95% CI, 1.02–1.64) but no significant association with trend (OR, 0.96; 95% CI, 0.93–1.01) of TOF monitoring (joint test, P = .04). Phase 3 and postintervention phase were not significantly associated with the frequency of TOF monitoring (joint test, P = .16 and P = .61). The study phases were not significantly associated with PPCs or sugammadex administration. The trend OR for 90-day mortality was larger by 24% (OR, 1.24; 95% CI, 1.06–1.45; joint test, P = .03) in phase 2 versus phase 1, from a weekly decrease of 8% to a weekly increase of 14%. However, this trend reversed again at the transition from phase 3 to the postintervention phase (OR, 0.82; 95% CI, 0.68–0.99; joint test, P = .05), from a 14% weekly increase to a 6.2% weekly decrease in the odds of 90-day mortality. In sensitivity analyses, adjusting for TOF monitoring, we found similar associations between study initiatives and postoperative outcomes. TOF monitoring was associated with lower odds of PPCs (OR, 0.69; 95% CI, 0.55–0.86) and 90-day mortality (OR, 0.79; 95% CI, 0.63–0.98), but not sugammadex dosing (mean difference, -0.02; 95% CI, -0.04 to 0.01). CONCLUSIONS: Our education-based interventions were associated with both TOF utilization and 90-day mortality but were not associated with either the odds of PPCs or sugammadex dosing. TOF monitoring was associated with reduced odds of PPCs and 90-day mortality.

show abstract

Impact of an Asynchronous Spaced Education Learning Intervention on Emergency Medicine Clinician Opioid Prescribing

Abstract: Barrett et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 4 publications

References 8 publications

An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform

An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform

Effect of Smartphone App–Based Education on Clinician Prescribing Habits in a Learning Health Care System

Improving Neuromuscular Monitoring Through Education-Based Interventions and Studying Its Association With Adverse Postoperative Outcomes: A Retrospective Observational Study

Contact Info

Product

Resources

About