Clinical Decision Support and Perioperative Peripheral Nerve Injury

Abstract

Decision support at the point of care has been demonstrated to be an effective tool in providing a safe environment and improving patient outcomes. The operating room is typically an area where advanced technology is introduced to nurses on a regular basis. This quality improvement project focused on preventing a peripheral nerve injury, which is an example of a postoperative adverse event that is considered preventable. Injury of a peripheral nerve is the result of compression, hyperextension, flexion, or ischemia surrounding the nerve. The goals for this project were to improve the knowledge of peripheral nerve injury of the operating room nurses, design and implement a peripheral nerve injury assessment screen that could provide decision support within the operating room record, improve the nursing documentation of peripheral nerve injury interventions, and (long term) decrease the incidence of peripheral nerve injury. A decision support screen within the operating room record was designed to supplement the operating room nurse's risk assessment for peripheral nerve injury. The components of this project involved a preliminary and postproject surveys on peripheral nerve injury knowledge, an educational presentation, and a retrospective random review of nursing documentation in the operating room electronic health records. Project results demonstrated a significant increase in nursing documentation of peripheral nerve injury interventions (63%-92%) and a positive attitude toward their exposure to basic decision support (P = .046). Recommendations for future studies and establishing a standardized coding system for peripheral nerve injury identification were identified.

Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning

“…Nevertheless, we consider it essential to train surgical teams and raise awareness of the risk and consequences of these types of injury. Recording a patient's positioning is an important step in increasing awareness of how to prevent PNI, as shown in the pilot study of Bouyer-Ferullo et al (2015). One of our future priorities is thus to develop a form to facilitate the recording of patient positioning during surgery for use in future research.…”

Guidelines in Practice: Positioning the Patient

“…Perioperative nurses should collaborate with all perioperative team members to develop a plan of care for minimizing the patient's risk of injury associated with positioning. Use of a decision‐support tool during preoperative assessments and planning may help team members identify at‐risk patients and possible interventions to decrease their risk 5 . The team should discuss the planned positioning interventions during the preoperative briefing, 1 which may promote team member awareness of the patient's specific needs and the required positioning equipment to maintain patient safety 6 .…”

“…Use of a decision-support tool during preoperative assessments and planning may help team members identify atrisk patients and possible interventions to decrease their risk. 5 The team should discuss the planned positioning interventions during the preoperative briefing, 1 which may promote team member awareness of the patient's specific needs and the required positioning equipment to maintain patient safety. 6 Perioperative team members should evaluate the effectiveness of the positioning interventions during the postoperative debriefing to identify patterns in outcomes associated with the interventions.…”

Nursing decision support system: application in electronic health records†

“…Bouyer et al 22 applied the NADSS in the operating room to deal with nursing records, which assists to increase the intervention measures for peripheral nerve injury, and reduced the incidence of peripheral nerve injury. Similarly, Fan and Shi 23 have integrated the NDSS with man-machine dialogue function into the structured EHR and implanted the clinical application module of nursing assessment.…”