Design and Implementation of a Nursing Clinical Decision Support System to Promote Guideline Adherence

Lyerla, Frank

doi:10.1097/01.ncn.0000304800.93003.b4

Cited by 17 publications

(12 citation statements)

References 29 publications

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“…However, physicians identified a number of barriers that were likely to reduce CDS utilization in clinical practice—the most common barrier being the increasing cognitive burden on providers due to EHR complexity and limited time during clinical encounters. These findings are supported by previous studies that examined barriers to CDS implementation [ 9 , 42 , 43 ].…”

Section: Discussionsupporting

confidence: 89%

An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia

Bangash

Pencille

Gundelach

et al. 2020

JPM

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Electronic health record (EHR)-based clinical decision support (CDS) can address the low awareness and undertreatment of familial hypercholesterolemia (FH), a disorder associated with a markedly increased risk of coronary heart disease. We aimed to incorporate provider perspectives into the development and implementation of a CDS tool for FH. An implementation science framework and a user-centered design process were used to create a CDS tool for FH. Primary care physicians and specialist physicians participated in qualitative interviews, usability testing and an implementation survey. The CDS was configured in two formats—a best practice alert (BPA) and an in-basket message and subsequently deployed in the EHR in silent mode. The key themes that emerged from the analysis of interview transcripts included understanding and awareness of FH, clinical workflow, physician preferences and value of CDS tools, perspectives on patient needs and values and dissemination and implementation. Recommendations related to usability included preferred CDS format and placement, content, timing and frequency, and level of alert urgency/prioritization. In response to the survey, 84.6% of physicians agreed that the CDS would improve early FH diagnosis and 92.3% agreed that it would help them identify and manage FH patients. Physician feedback led to iterative CDS refinement. In summary, we developed a CDS tool for FH using an implementation science framework and physician feedback. Initial deployment revealed a significant burden of FH and the potential for the CDS tool to have a large impact.

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Section: Discussionsupporting

confidence: 89%

An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia

Bangash

Pencille

Gundelach

et al. 2020

JPM

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“…There are no systematic reviews on the effect of computer reminders on nursing performance or patient outcomes; there are however systematic reviews on CDSS which have shown that CDSS effectiveness in nursing practice is still inconsistent and that further studies are needed in order to identify in which contexts they are most effective [ 16 , 17 ]. Studies in recent years of CDSS have shown improvement in nursing recording [ 18 ] and patient outcomes [ 19 ], but single studies of computer reminders have shown effect on nurses’ adherence to CPGs [ 20 ] and decreased omissions in nursing care [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of computer reminders on complications of peripheral venous catheters and nurses’ adherence to a guideline in paediatric care—a cluster randomised study

et al. 2015

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BackgroundReminder systems in electronic patient records (EPR) have proven to affect both health care professionals’ behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses’ (RNs’) self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention.MethodsThe study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs’ adherence to a PVC guideline, collected through a questionnaire that also included RNs’ perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention.ResultsNo significant effect was found for the computer reminders on PVC-related complications nor on RNs’ adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7–44.5) and 41.9 % (95 % CI 38.0–45.8), for the intervention group and 40.3 % (95 % CI 36.8–44.0) and 46.9 % (95 % CI 43.1–50.7) for the control. In general, RNs’ self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal.ConclusionsThe reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs.Trial registrationCurrent Controlled Trials ISRCTN44819426

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“…Additional information on the development and implementation of the nursing CDSS used in this study is reported elsewhere. 28 …”

Section: Study Design and Settingmentioning

confidence: 99%

A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation

Lyerla

LeRouge

Cooke

et al. 2010

American Journal of Critical Care

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Background Patients receiving mechanical ventilation are at high risk for pneumonia due to aspiration. Published guidelines recommend elevating the head of the bed 30º to 45º, if not contraindicated, to reduce risk, but this intervention is underused. Objectives To facilitate incorporating evidence-based practice by improving positioning of patients receiving mechanical ventilation and to identify patient and nurse characteristics that predict use of the guideline. Methods A modified interrupted time-series design was used. Data were collected on 43 patients and 33 nurses 3 separate times in a 12-bed intensive care unit at a medium-sized hospital. A total of 105 observations were recorded for analysis each time. Results Mean elevations of the head of the bed increased significantly from phase 1 (27.7º) to phase 2 (31.7º) and from phase 1 to phase 3 (31.1º). Elevations were higher for tube-fed patients than for patients not given enteral tube feedings. Elevations were higher for patients with a pulmonary-related diagnosis and lower for patients with a gastrointestinal diagnosis than for patients with other diagnoses. Elevations were lower for patients with a body mass index between 25.0 and 29.9 (overweight) than for patients with other body mass index values. Nurse characteristics were not significant predictors of elevation. Conclusion A nursing clinical decision support system integrated into a patient's electronic flow sheet can increase nurses' adherence to guidelines. Pulmonary and gastrointestinal diagnoses, body mass index, and tube feeding are predictors of elevation of the head of the bed.

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Design and Implementation of a Nursing Clinical Decision Support System to Promote Guideline Adherence

Cited by 17 publications

References 29 publications

An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia

An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia

Effects of computer reminders on complications of peripheral venous catheters and nurses’ adherence to a guideline in paediatric care—a cluster randomised study

A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation

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