Coupling the N-CODES System With Actual Nurse Decision-making

Integrative review of clinical decision support for registered nurses in acute care settings

Objective

To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses.

Materials and Methods

We performed an integrative review of qualitative and quantitative peer-reviewed original research studies using a structured search of PubMed, Embase, Cumulative Index to Nursing and Applied Health Literature (CINAHL), Scopus, Web of Science, and IEEE Xplore (Institute of Electrical and Electronics Engineers Xplore Digital Library). We included articles that reported on CDS targeting bedside nurses and excluded in stages based on rules for titles, abstracts, and full articles. We extracted research design and methods, CDS purpose, electronic health record integration, usability, and process and patient outcomes.

Results

Our search yielded 3157 articles. After removing duplicates and applying exclusion rules, 28 articles met the inclusion criteria. The majority of studies were single-site, descriptive or qualitative (43%) or quasi-experimental (36%). There was only 1 randomized controlled trial. The purpose of most CDS was to support diagnostic decision-making (36%), guideline adherence (32%), medication management (29%), and situational awareness (25%). All the studies that included process outcomes (7) and usability outcomes (4) and also had analytic procedures to detect changes in outcomes demonstrated statistically significant improvements. Three of 4 studies that included patient outcomes and also had analytic procedures to detect change showed statistically significant improvements. No negative effects of CDS were found on process, usability, or patient outcomes.

Discussion and Conclusions

Clinical support systems targeting bedside nurses have positive effects on outcomes and hold promise for improving care quality; however, this research is lagging behind studies of CDS targeting medical decision-making in both volume and level of evidence.

Considerations for a successful clinical decision support system

Clinical decision support systems have the potential to improve patient care in a multitude of ways. Clinical decision support systems can aid in the reduction of medical errors and reduction in adverse drug events, ensure comprehensive treatment of patient illnesses and conditions, encourage the adherence to guidelines, shorten patient length of stay, and decrease expenses over time. A clinical decision support system is one of the key components for reaching compliance for Meaningful Use. In this article, the advantages, potential drawbacks, and clinical decision support system adoption barriers are discussed, followed by an in-depth review of the characteristics that make a clinical decision support system successful. The legal and ethical issues that come with the implementation of a clinical decision support system within an organization and the future expectations of clinical decision support system are reviewed.

Clinical decision support systems in nursing: synthesis of the science for evidence-based practice

The aim of this article is to present a synthesis of the research literature on the state of nursing science regarding the development, use, and application of clinical decision support systems for the implementation of evidence-based practice in nursing. The authors sought to answer three specific questions in this metasynthesis: (1) What progress has nursing science made regarding the development and use of clinical decision support systems?; (2) What research methods and theoretical models are being applied by nurse researchers in this area?; and (3)Are there evidence-adaptive clinical decision support systems designed specifically to aid nurses' decisions related to evidence-based practice? Of 183 articles, 17 were included in the final analysis, and six were specific for clinical decision support systems to aid nurses in evidence-based practice. Implications for practice are considered, and recommendations for future research are made.

The N-CODES Project Moves to User Testing

For a technology to be implemented successfully, it must be thoroughly tested by the stakeholders who will use it in practice. This article reports on the user testing of the Nurse Computer Decision Support working prototype. Ten acute care nurses with varying levels of education and experience participated in the testing. The study's protocol consisted of a series of tasks requiring the participants to use the system while solving patient problems. Both quantitative and qualitative data on usability, ease of navigation, and nurse satisfaction were collected. The nurses ranked usability and ease of navigation highly. Nurses were excited about the system's clinical potential and felt that it would be useful to all practitioners regardless of experience. Testing the system in an actual clinical setting is the next step, but it is clear that the system has extraordinary potential to improve clinical decision making and patient outcomes.