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Van den Broucke E, Deleenheer B, Meulemans A, Vanderstappen J, Pauwels N, Cosaert K, Spriet I, Van Veer H, Vangoitsenhoven R, Sabino J, Declercq P, Vanuytsel T, Quintens C. Offering Guidance and Learning to Prescribers to Initiate Parenteral Nutrition using a Validated Electronic Decision TREE (OLIVE TREE). J Med Syst 2022; 46:56. [PMID: 35804275 DOI: 10.1007/s10916-022-01835-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Abstract
Parenteral nutrition (PN) is recommended in patients nutritionally at risk and unable to receive oral or enteral nutrition. A standardized electronic PN order format could enhance appropriate PN prescribing. We developed the OLIVE TREE (Offering guidance and Learning to prescribers to Initiate PN using a Validated Electronic decision TREE), embedded in our electronic health record. We aimed to evaluate its validity and impact on physicians' prescribing behavior. A non-randomized before-after study was carried out in a tertiary care center. The OLIVE TREE comprises 120 individual items. A process validation was performed to determine interrater agreement between a pharmacist and the treating physician. To estimate the proportion of patients for whom the OLIVE TREE had an effective and potential impact on physicians' prescribing behavior, a proof of concept study was conducted. The proportion of patients for whom PN was averted and the proportion of decisions not in line with the recommendation were also calculated. The process validation in 20 patients resulted in an interrater agreement of 95.0%. The proof of concept in 73 patients resulted in an effective and potential impact on prescribing behavior in 50.7% and 79.5% of these patients, respectively. Initiation of PN was not averted and recommendations of the OLIVE TREE were overruled in 42.5% of the patients. Our newly developed OLIVE TREE has a good process validity. A substantial impact on prescribing behavior was observed, although initiation of PN was not avoided. In the next phase, the decision tree will be implemented hospital-wide.
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Affiliation(s)
- Evelyne Van den Broucke
- Pharmacy Division, UZ Leuven, Louvain, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Barbara Deleenheer
- Pharmacy Division, UZ Leuven, Louvain, Belgium. .,Department of Chronic Diseases and Metabolism - Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Louvain, Belgium.
| | - Ann Meulemans
- Division of Endocrinology, UZ Leuven, Louvain, Belgium.,Department of Chronic diseases and Metabolism - Clinical and Experimental Endocrinology (CEE), KU Leuven, Louvain, Belgium
| | | | - Nelle Pauwels
- Division of Endocrinology, UZ Leuven, Louvain, Belgium.,Leuven Intestinal Failure and Transplantation (LIFT), UZ Leuven, Louvain, Belgium
| | | | - Isabel Spriet
- Pharmacy Division, UZ Leuven, Louvain, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Hans Van Veer
- Division of Thoracic Surgery, UZ Leuven, Louvain, Belgium.,Department of Chronic Diseases and Metabolism - Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE) - Lung Transplant Unit, KU Leuven, Louvain, Belgium
| | - Roman Vangoitsenhoven
- Division of Endocrinology, UZ Leuven, Louvain, Belgium.,Department of Chronic diseases and Metabolism - Clinical and Experimental Endocrinology (CEE), KU Leuven, Louvain, Belgium
| | - João Sabino
- Department of Chronic Diseases and Metabolism - Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Louvain, Belgium.,Division of Gastroenterology and Hepatology, UZ Leuven, Louvain, Belgium
| | - Peter Declercq
- Pharmacy Division, UZ Leuven, Louvain, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Tim Vanuytsel
- Department of Chronic Diseases and Metabolism - Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Louvain, Belgium.,Leuven Intestinal Failure and Transplantation (LIFT), UZ Leuven, Louvain, Belgium.,Division of Gastroenterology and Hepatology, UZ Leuven, Louvain, Belgium
| | - Charlotte Quintens
- Pharmacy Division, UZ Leuven, Louvain, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
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