SEPREVEN: a Stepped-wedge Randomised Controlled Trial

NCT ID: NCT02598609

Last Updated: 2020-12-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

8000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-11-23

Study Completion Date

2020-12-08

Brief Summary

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Adverse events are frequent in Neonatal Intensive Care Units' (NICU) patients and account for a high morbidity and mortality. Possible severe adverse events are central line associated bloodstream infections (CLABSI), ventilator and catheter associated adverse events and medication errors. Severity of the patient's outcome after an adverse event can be classified using the National Coordinating Council for Medication Error Reporting and Preventing (NCC MERP) Index for categorizing medication errors.

The study will test the hypothesis that rates of adverse events in NICU patients will be reduced by the implementation of an educational program for the NICU caregivers (nurses and physicians), consisting of strategies for recognizing and preventing adverse events in their unit. These strategies will be oriented to prevent CLABSI, medication errors, skin and nasal complications and ventilator and catheter-associated adverse events.

This trial has a stepped wedge cluster design, in which the NICUs from 12 hospitals in France will be randomized to the timing of implementation of the educational program.

In order to describe the adverse events occurring during the study period, an anonymous voluntary adverse event reporting system will be provided to the caregivers of the participating units. A nested study will examine how caregivers communicate with the patients' parents in case of adverse event (disclosure or not, and caregivers' reasons).

The rates of adverse events will be measured retrospectively using a neonatal NICU trigger tool.

Detailed Description

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Conditions

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Intensive Care Units, Neonatal Misadventures to Patients During Surgical and Medical Care Catheter-related Bloodstream Infection (CRBSI) Nos Quality of Healthcare Ventilator Adverse Event Nosocomial Pneumonia Immature Newborn Skin Lesion Extravasation Injury Nasal Injury Intubation Complication Medication Administered in Error IV Catheter Nos Deep Venous Thrombosis

Keywords

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Adverse event Neonatal Intensive Care Unit Catheter-related Bloodstream Infection (CRBSI) nos Extravasation injury Medication error Central venous catheter complication Unprogrammed extubation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Cluster A

Out of the 12 participating NICUs, 4 NICUs are randomly assigned in Cluster A. The intervention (educational program for preventing adverse events and medical errors in the NICU) is implemented after a pre interventional period of 4 months. The intervention is implemented during 4 months. The length of the post interventional period is 12 months.

Group Type OTHER

Education program for NICU caregivers

Intervention Type BEHAVIORAL

* standardized educational program : learning how to retrospectively analyze causes of a medical error in the NICU in order to prevent it (compulsory)
* implementation of a central line maintenance bundle and checklist, of a central line insertion bundle and checklist and of a daily goals bundle and checklist. (compulsory)
* poster for prevention of extravasation injuries

Cluster B

Out of the 12 participating NICUs, 4 NICUs are randomly assigned in Cluster B. The intervention (educational program for preventing adverse events and medical errors in the NICU) is implemented after a pre interventional period of 8 months. The intervention is implemented during 4 months. The length of the post interventional period is 8 months.

Group Type OTHER

Education program for NICU caregivers

Intervention Type BEHAVIORAL

* standardized educational program : learning how to retrospectively analyze causes of a medical error in the NICU in order to prevent it (compulsory)
* implementation of a central line maintenance bundle and checklist, of a central line insertion bundle and checklist and of a daily goals bundle and checklist. (compulsory)
* poster for prevention of extravasation injuries

Cluster C

Out of the 12 participating NICUs, 4 NICUs are randomly assigned in Cluster C. The intervention (educational program for preventing adverse events and medical errors in the NICU) is implemented after a pre interventional period of 12 months. The intervention is implemented during 4 months. The length of the post interventional period is 4 months.

Group Type OTHER

Education program for NICU caregivers

Intervention Type BEHAVIORAL

* standardized educational program : learning how to retrospectively analyze causes of a medical error in the NICU in order to prevent it (compulsory)
* implementation of a central line maintenance bundle and checklist, of a central line insertion bundle and checklist and of a daily goals bundle and checklist. (compulsory)
* poster for prevention of extravasation injuries

Interventions

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Education program for NICU caregivers

* standardized educational program : learning how to retrospectively analyze causes of a medical error in the NICU in order to prevent it (compulsory)
* implementation of a central line maintenance bundle and checklist, of a central line insertion bundle and checklist and of a daily goals bundle and checklist. (compulsory)
* poster for prevention of extravasation injuries

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Patients hospitalized during the study period in one of the 12 participating Neonatal Intensive Care Units
* Corrected Gestational age not exceeding 42 weeks +6 days at the time of admission in the NICU
* Length of hospitalisation in the NICU \> 2 days
* No parental objection to the anonymous data collection of their newborn(s)' clinical data, after written information

Exclusion Criteria

* More than 42 weeks +6 days of corrected gestational age on admission in the NICU
* Length of hospitalization in the NICU \< or = 2 days
* Parental objection to the anonymous data collection of their newborn(s)' clinical data
Minimum Eligible Age

1 Day

Maximum Eligible Age

20 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Paris 12 Val de Marne University

OTHER

Sponsor Role collaborator

Ministry of Health, France

OTHER_GOV

Sponsor Role collaborator

Dr Caeymaex Laurence

OTHER

Sponsor Role lead

Responsible Party

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Dr Caeymaex Laurence

Dr, PhD

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Laurence Caeymaex, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

CHI Creteil, Paris Est University

Locations

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CHU Strasbourg Hautepierre

Strasbourg, Alsace, France

Site Status

CHU Grenoble

Grenoble, Auvergne-Rhône-Alpes, France

Site Status

CHU Lille Jeanne de Flandres

Lille, Hauts-de-France, France

Site Status

CHU Caen

Caen, Normandy, France

Site Status

CHU Angers

Angers, Pays de la Loire Region, France

Site Status

CHU Nice Archet

Nice, Provence-Alpes-Côte d'Azur Region, France

Site Status

CHI Creteil

Créteil, Île-de-France Region, France

Site Status

CHU Bicêtre, APHP

Le Kremlin-Bicêtre, Île-de-France Region, France

Site Status

CHU Robert Debré, APHP

Paris, Île-de-France Region, France

Site Status

CH Poissy

Poissy, Île-de-France Region, France

Site Status

CH Pontoise René Dubos

Pontoise, Île-de-France Region, France

Site Status

Centre Hospitalier Delafontaine

Saint-Denis, Île-de-France Region, France

Site Status

Countries

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France

References

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Sharek PJ, Horbar JD, Mason W, Bisarya H, Thurm CW, Suresh G, Gray JE, Edwards WH, Goldmann D, Classen D. Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs. Pediatrics. 2006 Oct;118(4):1332-40. doi: 10.1542/peds.2006-0565.

Reference Type BACKGROUND
PMID: 17015521 (View on PubMed)

Sharek PJ. The Emergence of the Trigger Tool as the Premier Measurement Strategy for Patient Safety. AHRQ WebM&M. 2012 May 1;2012(5):120. No abstract available.

Reference Type BACKGROUND
PMID: 23667349 (View on PubMed)

Chedoe I, Molendijk H, Hospes W, Van den Heuvel ER, Taxis K. The effect of a multifaceted educational intervention on medication preparation and administration errors in neonatal intensive care. Arch Dis Child Fetal Neonatal Ed. 2012 Nov;97(6):F449-55. doi: 10.1136/fetalneonatal-2011-300989. Epub 2012 Apr 5.

Reference Type BACKGROUND
PMID: 22491014 (View on PubMed)

Dabliz R, Levine S. Medication safety in neonates. Am J Perinatol. 2012 Jan;29(1):49-56. doi: 10.1055/s-0031-1285831. Epub 2011 Aug 22.

Reference Type BACKGROUND
PMID: 21861251 (View on PubMed)

Palmero D, Di Paolo ER, Beauport L, Pannatier A, Tolsa JF. A bundle with a preformatted medical order sheet and an introductory course to reduce prescription errors in neonates. Eur J Pediatr. 2016 Jan;175(1):113-9. doi: 10.1007/s00431-015-2607-4. Epub 2015 Aug 15.

Reference Type BACKGROUND
PMID: 26272253 (View on PubMed)

Fisher D, Cochran KM, Provost LP, Patterson J, Bristol T, Metzguer K, Smith B, Testoni D, McCaffrey MJ. Reducing central line-associated bloodstream infections in North Carolina NICUs. Pediatrics. 2013 Dec;132(6):e1664-71. doi: 10.1542/peds.2013-2000. Epub 2013 Nov 18.

Reference Type BACKGROUND
PMID: 24249819 (View on PubMed)

Smulders CA, van Gestel JP, Bos AP. Are central line bundles and ventilator bundles effective in critically ill neonates and children? Intensive Care Med. 2013 Aug;39(8):1352-8. doi: 10.1007/s00134-013-2927-7. Epub 2013 Apr 25.

Reference Type BACKGROUND
PMID: 23615702 (View on PubMed)

Schulman J, Stricof R, Stevens TP, Horgan M, Gase K, Holzman IR, Koppel RI, Nafday S, Gibbs K, Angert R, Simmonds A, Furdon SA, Saiman L; New York State Regional Perinatal Care Centers. Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics. 2011 Mar;127(3):436-44. doi: 10.1542/peds.2010-2873. Epub 2011 Feb 21.

Reference Type BACKGROUND
PMID: 21339265 (View on PubMed)

Casanova D, Bardot J, Magalon G. Emergency treatment of accidental infusion leakage in the newborn: report of 14 cases. Br J Plast Surg. 2001 Jul;54(5):396-9. doi: 10.1054/bjps.2001.3593.

Reference Type BACKGROUND
PMID: 11428769 (View on PubMed)

Collins CL, Barfield C, Horne RS, Davis PG. A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure. Eur J Pediatr. 2014 Feb;173(2):181-6. doi: 10.1007/s00431-013-2139-8. Epub 2013 Aug 18.

Reference Type BACKGROUND
PMID: 23955516 (View on PubMed)

Farquhar C, Armstrong S, Kim B, Masson V, Sadler L. Under-reporting of maternal and perinatal adverse events in New Zealand. BMJ Open. 2015 Jul 23;5(7):e007970. doi: 10.1136/bmjopen-2015-007970.

Reference Type BACKGROUND
PMID: 26204910 (View on PubMed)

Raju TN, Suresh G, Higgins RD. Patient safety in the context of neonatal intensive care: research and educational opportunities. Pediatr Res. 2011 Jul;70(1):109-15. doi: 10.1203/PDR.0b013e3182182853.

Reference Type BACKGROUND
PMID: 21386749 (View on PubMed)

Garland JS, Alex CP, Uhing MR, Peterside IE, Rentz A, Harris MC. Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates. J Perinatol. 2009 Dec;29(12):808-13. doi: 10.1038/jp.2009.161. Epub 2009 Oct 8.

Reference Type BACKGROUND
PMID: 19812587 (View on PubMed)

Yager H, Tauzin M, Durrmeyer X, Todorova D, Storme L, Debillon T, Casagrande F, Jung C, Audureau E, Layese R, Caeymaex L; SEPREVEN Study Group. Respiratory outcomes and survival after unplanned extubation in the NICU: a prospective cohort study from the SEPREVEN trial. Arch Dis Child Fetal Neonatal Ed. 2024 Oct 18;109(6):586-593. doi: 10.1136/archdischild-2023-326679.

Reference Type DERIVED
PMID: 38636983 (View on PubMed)

Jaloustre M, Cohen R, Biran V, Decobert F, Layese R, Audureau E, Le Sache N, Chevallier M, Boukhris MR, Bolot P, Caeymaex L, Tauzin M; with the SEPREVEN study Group. Determinants of morbidity and mortality related to health care-associated primary bloodstream infections in neonatal intensive care units: a prospective cohort study from the SEPREVEN trial. Front Pediatr. 2023 May 31;11:1170863. doi: 10.3389/fped.2023.1170863. eCollection 2023.

Reference Type DERIVED
PMID: 37325351 (View on PubMed)

Passini L, Le Bouedec S, Dassieu G, Reynaud A, Jung C, Keller ML, Lefebvre A, Katty T, Baleyte JM, Layese R, Audureau E, Caeymaex L; SEPREVEN Study Group. Error disclosure in neonatal intensive care: a multicentre, prospective, observational study. BMJ Qual Saf. 2023 Oct;32(10):589-599. doi: 10.1136/bmjqs-2022-015247. Epub 2023 Mar 14.

Reference Type DERIVED
PMID: 36918264 (View on PubMed)

Caeymaex L, Astruc D, Biran V, Marcus L, Flamein F, Le Bouedec S, Guillois B, Remichi R, Harbi F, Durrmeyer X, Casagrande F, Le Sache N, Todorova D, Bilal A, Olivier D, Reynaud A, Jacquin C, Roze JC, Layese R, Danan C, Jung C, Decobert F, Audureau E. An educational programme in neonatal intensive care units (SEPREVEN): a stepped-wedge, cluster-randomised controlled trial. Lancet. 2022 Jan 22;399(10322):384-392. doi: 10.1016/S0140-6736(21)01899-7.

Reference Type DERIVED
PMID: 35065786 (View on PubMed)

Caeymaex L, Lebeaux C, Roze JC, Danan C, Reynaud A, Jung C, Audureau E. Study on preventing adverse events in neonates (SEPREVEN): A stepped-wedge randomised controlled trial to reduce adverse event rates in the NICU. Medicine (Baltimore). 2020 Jul 31;99(31):e20912. doi: 10.1097/MD.0000000000020912.

Reference Type DERIVED
PMID: 32756081 (View on PubMed)

Other Identifiers

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SEPREVEN

Identifier Type: -

Identifier Source: org_study_id