[MUSIC] I'd like to discuss the issue of nurse education as a pathway to quality improvement. So we've talked a lot about venous thromboembolism in other parts of this course. And we've talked about how nurses are a critical aspect of bringing data and information to patients, and how nurses are a critical step to making sure patients get perfect care. The physician needs to order the right medications. The nurse needs to give it. And the patient needs to accept it. So today we're here to talk about the education approach to make sure nurses realize how important VTE prophylaxis is. So we did a study. We started by partnering with Central Nurse Education, here at Johns Hopkins Hospital, to build two types of educational programs into the MyLearning Platform. That's the online education program for nurses at John's Hopkins. And it's actually the program for all provider of all different types at Johns Hopkins as well. So the reason we ended up doing two different types was we originally were going to build our typical linear static education. And then along came someone who had some expertise and wanted to try a new type of education, and that's what I'm going to show you we ended up comparing. So what did we start with? We started with a static PowerPoint slides with voice over. We then compared that to a learner-centric interactive scenario-based education. This has more interaction, it has avatars, it has you, it has your patients, it asks you questions. If you get the question right, you go in one direction. If you get the question wrong, you go back for more remediation. Depending what you answer, it's going to send you to different pieces. It's much more interactive. You really need to pay attention and interact with the computer. So it's a different approach to education. So we now as these two types of education, and what did we do? We did a cluster randomized trial on 21 medical surgical floors and what we do is we cluster randomize by floor. All the nurses on that floor were given the same type of education. They were assigned to either the static PowerPoint with voiceover or the dynamic video game style education. All nurses on the same floor did the same type of education, and half the floors were assigned to one, and half the floors were assigned to the other. And we also administered satisfaction scores, or satisfaction surveys, after the end of the education, for the nurses to fill them out. So the nurses were assigned, they went on the computer, they went to their one type of education, they did their education, and they filled in a survey. And what did we look at as our outcome? Our outcome is actually dose administration. We're going to talk about how important that is as an outcome later on. So what are the results? Overall, non administration improved significantly following education. The overall rate, our proportion when from 12 and a 1/2 to 11%, a significant drop in the proportion. And the conditional odds ratio controlling for lots of other things, the conditional odds ratio, 13% decreased odds of misdoses in the after period after the education after the nurses did. Okay, it makes a big difference. Education works to change clinical practices of nurses. Turns out the nurses also liked it a lot better. They liked this dynamic education significantly more than the static education in every single question asked. Is the course directly applicable? Will it help me communicate with my patients? I enjoyed this learning intervention. I found the course engaging. The course provided the right level of information and resources. Every single one of those questions was statistically higher score for the nurses in the dynamic arm. So when you apply a learning theory approach, this is Kirkpatrick’s Learning Evaluation Theory as it’s applied to VTE. So we could have just studied the reaction, yes, they like the course. Or the module completion, yes, there’s some percentage of nurses that actually did the education. Bu what did we studied? We studied behavior. We studied the actual missed doses of nurses. You can actually study nurse a took the course on Tuesday, March 11th and then you could find out her individual missed doses for the time before and the time after. Got down to that nitty-gritty detail, and the missed doses are the critical part. So for those of you out there on Twitter, you'll hopefully recognize the visual abstract. This summarizes this whole research study, this large clinical trial that enrolled nearly 1,000 nurses into one infographic, and here it is. Education works, VTE prophylaxis improved after nursing education. There's no statistically significant difference between the arms, although some might say that the dynamic scenario-based was better than the other. It really depends on exactly how you look at the statistics. But there's certainly higher satisfaction. And when you combine those data, we've now started rolling out the dynamic scenario-based education to all nurses at our hospital. And we're working to roll it out actually to the rest of the world. And hopefully soon, you'll be able to go to the Armstrong Institute website and log on and take this course.
