Clinical decision support systems in the care of inpatients with diabetes in non‐critical care setting: systematic review

Nirantharakumar, Krishnarajah; Chen, Yen-Fu; Marshall, Tom; Webber, Jonathan; Coleman, Jamie J.

doi:10.1111/j.1464-5491.2011.03540.x

Cited by 45 publications

(55 citation statements)

References 43 publications

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“…Insulin therapy was implicated in at least 10 of these events 23. It is hoped that in the future electronic prescribing and clinical decision support systems will help to minimise these errors while recognising that such systems are not infallible and will not prevent errors either in insulin administration or in management decisions 24 25…”

Section: Discussionmentioning

confidence: 99%

Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes

2014

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ObjectivesTo determine whether temporal patterns of hypoglycaemia exist in inpatients with diabetes ‘at risk’ of hypoglycaemia (those on insulin and/or sulfonylureas), and if so whether patterns differ between hospitals and between these treatments.SettingRetrospective multicentre audit of inpatients with diabetes involving 11 acute UK National Health Service (NHS) trusts.ParticipantsCapillary blood glucose readings of 3.9 mmol/L or less (hypoglycaemia) for all adult (≥18 years) inpatients with diabetes ‘at risk’ of hypoglycaemia were extracted from the Abbott PrecisionWeb Point-of-Care Data Management System over a 4-week period. Overall, 2521 readings of 3.9 mmol/L or less (hypoglycaemia) occurring in 866 participants between 1 June 2013 and 29 June 2013 were analysed.ResultsThe majority (65%) occurred between 21:00 and 08:59, a pattern common to all Trusts. This was more frequent in sulfonylurea-treated than insulin-treated participants (75.3% vs 59.3%, p=0.0001). Furthermore, hypoglycaemic readings were more frequent between 5:00 and 7:59 in sulfonylurea-treated than insulin-treated participants (46.7% vs 22.7% of readings for respective treatments, p=0.0001). Sulfonylureas accounted for 31.8% of all hypoglycaemic readings. As a group, sulfonylurea-treated participants were older (median age 78 vs 73 years, p=0.0001) and had lower glycated haemoglobin (median 56 (7.3%) vs 69 mmol/mol (8.5%), p=0.0001). Hypoglycaemic readings per participant were as frequent for sulfonylurea-treated participants as for insulin-treated participants (median=2 for both) as were the proportions in each group with ≥5 hypoglycaemic readings (17.3% vs 17.7%).ConclusionsIn all Trusts, hypoglycaemic readings were more frequent between 21:00 and 08:59 in ‘at risk’ inpatients with diabetes, with a greater frequency in the early morning period (5:00–7:59) in sulfonylurea-treated inpatients. This may have implications for the continuing use of sulfonylureas in the inpatient setting.

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Section: Discussionmentioning

confidence: 99%

Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes

2014

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“…2,4,5 For effective use of the CDSS, users need to adopt it to achieve its ultimate purpose of improving patient clinical outcomes and safety. 1,4,[6][7][8] The assurance of success in translating knowledge into evidence-based practice lies in the adoption of the CDSS after implementation. 9 Over the years, several studies and reviews have been conducted focusing on practitioners' acceptance and use.…”

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confidence: 99%

A Critical Review of the Theoretical Frameworks and the Conceptual Factors in the Adoption of Clinical Decision Support Systems

Khong

Holroyd

Wang

2015

CIN: Computers, Informatics, Nursing

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The clinical decision support system is utilized to translate knowledge into evidence-based practice in clinical settings. Many studies have been conducted to understand users' adoption of the clinical decision support system. A critical review was conducted to understand the theoretical or conceptual frameworks used to inform the studies on the adoption of the clinical decision support system. The review identified 15 theoretical and conceptual frameworks using multiple hybrids of theories and concepts. The Technology Acceptance Model was the most frequently used baseline framework combined with frameworks such as the diffusion of innovation, social theory, longitudinal theory, and so on. The results from these articles yielded multiple concepts influencing the adoption of the clinical decision support system. These concepts can be recategorized into nine major concepts, namely, the information system, person (user or patient), social, organization, perceived benefits, emotions, trustability, relevance (fitness), and professionalism. None of the studies found all the nine concepts. That said, most of them have identified the information system, organization, and person concepts as three of its concepts affecting the use of the clinical decision support system. Within each of the concepts, its subconcepts were noted to be very varied. Yet each of these subconcepts has significantly contributed toward the different facets of the concepts. A pluralistic framework was built using the concepts and subconcepts to provide an overall framework construct for future study on the adoption of the clinical decision support system.

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“…Possible electronic implementation approaches are validated alerts and guidelines on the prescription of antidiabetic medication, especially insulin. 1,19,[27][28][29] In summary, our results show insufficient control of hyperglycemia in noncritically ill hospitalized patients with diabetes despite considerable glycemic management efforts. While the data indicate substantial glycemic management effort in the care of diabetes patients, it did not result in appropriate glycemic control according to recent guidelines.…”

Section: Discussionmentioning

confidence: 75%

Failure to Control Hyperglycemia in NonCritically Ill Diabetes Patients despite Standard Glycemic Management in a Hospital Setting

Neubauer

Schaupp

Plank

et al. 2013

J Diabetes Sci Technol

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Clinical decision support systems in the care of inpatients with diabetes in non‐critical care setting: systematic review

Abstract: Clinical decision support systems have been used, often as part of a complex programme, to improve the care of hospitalized patients with diabetes. There is some evidence that they may have a beneficial effect, but this needs further confirmation.

Cited by 45 publications

References 43 publications

Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes

Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes

A Critical Review of the Theoretical Frameworks and the Conceptual Factors in the Adoption of Clinical Decision Support Systems

Failure to Control Hyperglycemia in NonCritically Ill Diabetes Patients despite Standard Glycemic Management in a Hospital Setting

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