DNP 805 Select a particular medication or clinical problem
DNP 805 Select a particular medication or clinical problem
One of the major concerns in the clinical environment is patient safety. The implication is that various stakeholders have to use strategies that ensure patient safety and efficient patient service. Some of these problems are clinical or medication problems. In recent times, technology has played a significant role in solving these problems. In particular, the clinical decision support system and the computerized physician order entry system have been at the center stage of solving medication and clinical problems (Sutton et al., 2020).
One case where a combination of the two technologies can be combined for better outcomes is the case of a critically ill patient or patients living with more than one condition. Such patients usually require several medications and tests. The implication is that the volume of treatments and orders for these patients are high hence increasing the chances of confusion and medication errors (Liu et al., 2020). The computerized physician order entry system can be key in such a case in organizing and updating new orders or entries that have been created by the healthcare providers. Such updates and organization increase the efficiency of patient care. In addition, treatment and medication error incidences are lowered, and the quality of care is also improved.
The use of a clinical decision support system can also be key in such a case. CDSS analyses data that can then be used in making decisions and improving patient care. Critically ill patients and patients living with more than one chronic condition are usually in need of quality care and special attention (Liu et al., 2020). The use of CDSS is important in such cases as it helps the healthcare professionals to make better decisions regarding their care, hence better outcomes.
Liu, S., See, K. C., Ngiam, K. Y., Celi, L. A., Sun, X., & Feng, M. (2020). Reinforcement learning for clinical decision support in critical care: comprehensive review. Journal of Medical Internet Research, 22(7), e18477. https://doi.org/10.2196/18477
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ digital medicine, 3(1), 1-10. https://doi.org/10.1038/s41746-020-0221-y
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Patient safety in general is important and the systems CDSS does ensure safety on all levels. Patients who are in behavioral health for example, when placed in restraints, the system generated CDSS reminds the nurses to check the restraints to ensure that the restraints are released Q2H, and circulation checks are done. When an IV is inserted, the CDSS generated by the system ensures that the IV care is done. If a Foley Cather is inserted, it reminds the nurses to perform catheter care. Patients on specific medications for example patches, the system reminds and alerts the nurses to perform patch checks and to document where their patches re placed. If a note is incomplete, regarding documentation, it is flagged in the system and clinician can see that the task is incomplete and needs to be completed. So overall we do have reminders and alerts that the system generates for patient safety in general.
Clinical decision support systems has greatly influenced health care today. A medication issue that is often overlooked is prescribing the correct antibiotic. Antibiotic prescription plays an imperative role when treating infectious diseases. Studies show that there has been an increase in bacterial resistance rates, making it more complicated to prescribe the correct empiric antibiotic treatment (Metcalfe et al., 2017). With this, different programs are implemented to ensure the rational prescription of antibiotics. Programs such as antibiotic stewardship programs aim to optimize prescription to increase guideline adherence, which may lead to the reduction of antibiotic use (Metcalfe et al., 2017). In a study conducted by Neugebauer and Vogelmann (2020), an antibiotic stewardship program was used to improve the use of antibiotics. The study showed that medical professions indeed require additional tools such as a CDSS to ensure the correct antibiotic was used for particular diseases. The system also provided recommended doses based on the patients age, labs, and other necessary information.
Metcalfe, J., Lam, A., Lam, S. S. H., Clifford, J. ‐ M., & Schramm, P. (2017). Impact of the introduction of computerized physician order entry ( CPOE) on the surveillance of restricted antimicrobials and compliance with policy. Journal of Pharmacy Practice & Research, 47(3), 200–206. https://doi-org.lopes.idm.oclc.org/10.1002/jppr.1227
Neugebauer, M. Ebert, & R. Vogelmann. (2020). A clinical decision support system improves antibiotic therapy for upper urinary tract infection in a randomized single-blinded study. BMC Health Services Research, 20(1), 1–10. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-020-5045-6
CDSS is great at influencing the care delivery system positive as they improve the efficiency of the care processes by as they enhance all the safety measures that have been embedded in all the HIT tools being used by the HCP. The CDSS use the clinical information and the parameters that have been set or programmed to provide clinical-decision support to the HCP. The CDSS supports care decisions based on the standardized controlled data that is entered based on knowledge base and the reasoning capacity of the system and the communication output. Hence the frequently used adage of “garbage in- garbage out”. The CDSS would only make a decision based on what was programmed and what was entered as documentation. So, we have to require that all those who input information into the system are doing so accurately. To further patient safety, prevent delays with care (Alexander, Hoy, & Frith, 2019).
For instance, in the area of registration to admit patients into the hospitals. The registrar’s office in the emergency room has a tendency of not updating the information in the records. We find that most times, the patients do not have the correct address or the correct phone number, or there is no emergency contact, sometimes, to move forward they enter the patients name as the emergency contact and this causes a problem when there is an emergency situation and the hospital cannot contact anyone because no one has come to see the patient or no one realized that there was no true emergency contact listed and the worse is that sometimes the listed emergency contact is someone that has died maybe one or two years prior. The CDSS can support care here if there is a trigger that makes them enter new information rather than relying on the old information. It will prevent the delays with trying to find family members to consent to a procedure when it is not an emergency.
The CDSS when it is used for cardiovascular disease preventive measures, it can be used as a screening mechanism to remind the HCP to screen for certain risk factors and asking a series of questions on how they adhere to their medications and the type of treatments they have utilized and recommendations for certain health behavior modifications. For instance, In South Omaha Medical Associates (SOMA), they have a high percentage of low-income patients more that they have clinics, so they performed an assessment, in collaboration with other health departments and they realized that they needed to increase their use of EHR and implement CDSS. This has helped them to identify patients who were undiagnosed with risk factors for cardiovascular diseases. With the use of CDSS, they increase their monitoring of quality measures and self-measuring of blood pressures which has improved their workflow and led to a 25% rise in patients coming to the clinic and improved patient safety outcomes (CDC, 2020).
Alexander, S., Hoy, H., & Frith, K. (2019). Applied clinical informatics for nurses (2nd ed.). Jones & Bartlett Learning.
Centers for Disease Control and Prevention (CDC). (2020, July 7). How to implement clinical decision support systems. Centers for Disease Control and Prevention.
One clinical problem that can be improved is the care of patients presenting with sepsis. Over the years thru lots of research there have been developments on what sepsis is and how best to diagnose and treat it. These findings have assisted in decreasing mortality. This is one of the reasons that it has become a tracked measure for the Center for Medicare and Medicaid. This is also linked to reimbursement. At my facility we have used a Clinical Decision Support System (CDSS) to assist in improving patient care and outcomes. One way we do this is thru an automatic sepsis screening tool that assists in early identification and escalation. This timely recognition is tied to decreased morbidity and mortality (Baker, 2022). There are also best practice advisories that populate to assure that documentation components are completed such as two blood pressures within the first hour after a 30cc/kg fluid bolus. Thru utilizing a computerized provider order entry there can also be additional things added to help with improving sepsis care. One example of this is having sepsis specific order sets that helps to guide the provider on exactly what should be ordered or considered. This helps assure all components of the measure are met.
Baker, E. (2022). Improving sepsis recognition through use of the Sepsis Trust’s community screening tool. British Journal of Community Nursing, 27(2), 69–75. https://doi-org.lopes.idm.oclc.org/10.12968/bjcn.2022.27.2.69