Clinical Decision Support Systems in Nursing

Clinical Decision Support Systems in Nursing

Dawn Dowding (University of York, UK), Rebecca Randell (City University, UK), Natasha Mitchell (University of York, UK), Rebecca Foster (University of Southampton, UK), Valerie Lattimer (University of Southampton, UK) and Carl Thompson (University of York, UK)
Copyright: © 2009 |Pages: 15
DOI: 10.4018/978-1-60566-234-3.ch003
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Abstract

Increasingly, new and extended roles and responsibilities for nurses are being supported through the introduction of clinical decision support systems (CDSS). This chapter provides an overview of research on nurses’ use of CDSS, considers the impact of CDSS on nurse decision making and patient outcomes, and explores the socio-technical factors that impact the use of CDSS. In addition to summarising previous research, both on nurses’ use of CDSS and on use of CDSS more generally, the chapter presents the results of a multi-site case study that explored how CDSS are used by nurses in practice in a range of contexts. The chapter takes a socio-technical approach, exploring the barriers and facilitators to effective CDSS use at a level of the technology itself, the ways people work, and the organisations in which they operate.
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Background

Definitions

Clinicians have a range of decision tools available to them to support their decision making (Liu, Wyatt, & Altman, 2006). Examples of decision tools include nomograms (charts that simplify complex information such as Body Mass Index (BMI)), templates incorporated into electronic patient records (EPRs), predictive scores (such as early warning scoring systems for clinical event risk), formularies to support prescribing, and patient information leaflets. CDSS are a computer-based form of decision tool, integrating information (ideally from high-quality research studies) with the characteristics of individual patients, to provide advice to clinicians (Dowding, 2007). As such, CDSS are seen as a potential way of improving the quality, safety and effectiveness of clinical decisions, leading to improvement in clinician performance and patient outcomes (Garg et al., 2005). CDSS vary in their functionality, from ‘passive’ systems that only provide information to a clinician when they request it, through to ‘active’ systems that provide patient specific recommendations to a clinician automatically (Hajioff, 1998). For example, computerised clinical reminders (CRs) are an example of an active system, typically being integrated with an electronic patient record (EPR) and presenting reminders to the clinician regarding potentially appropriate interventions, based on an evaluation of the available patient data (Patterson, Nguyen, Halloran, & Asch, 2003Saleem et al., 2005). Computerised provider order entry (CPOE), which enables computer-based ordering of medication, can also be a form of active CDSS, when decision support alerts the user to the risk of a dangerous drug interaction or advises the user of appropriate dosages (Aarts, Doorewaard, & Berg, 2004). Passive CDSS include electronic information tools that provide clinicians with access to online clinical practice guidelines and research evidence (Randell, Mitchell, Thompson, McCaughan, & Dowding, In press-a).

CDSS have a long history; a systematic review of the impact of CDSS contained 5 studies that were published in the 1970s (Garg et al., 2005). The review identified 100 studies, covering the activities of diagnosis, disease management and drug dosing and prescribing, and a range of clinical areas, including both primary and secondary care.

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Editorial Advisory Board
Table of Contents
Foreword
Peter J. Murray
Preface
Bettina Staudinger
Acknowledgement
Chapter 1
Wanda Sneed
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A Treatise on Rural Public Health Nursing
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Chapter 2
Elfriede Fritz, Daniela Deufert, Johannes Hilbe
Experience in nursing practice shows that, in Austria, there are still problems with assessment in computer-based nursing documentation. Nursing... Sample PDF
Assessment in a Computer-Based Nursing Documentation
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Chapter 3
Dawn Dowding, Rebecca Randell, Natasha Mitchell, Rebecca Foster, Valerie Lattimer, Carl Thompson
Increasingly, new and extended roles and responsibilities for nurses are being supported through the introduction of clinical decision support... Sample PDF
Clinical Decision Support Systems in Nursing
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Chapter 4
Jerono P. Rotich
This chapter will give an overview of the healthcare-related challenges that most newcomer immigrants and refugees encounter as they acculturate... Sample PDF
Culturally Sensitive Healthcare for Newcomer Immigrants
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Chapter 5
Pammla Petrucka, Sandra Bassendowski, Thomas F. James, Hazel Roberts, June Anonson
This chapter presents the imperatives of mobile technologies in healthcare as these impact (or potentially) impact on development. It presents the... Sample PDF
Mobile Technology in a Developing Context: Impacts and Directions for Nursing
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Chapter 6
Kenric W. Hammond, Charlene R. Weir, Efthimis N. Efthimiadis
Computerized patient care documentation (CPD) is a vital part of a Patient Care Information System (PCIS). Studying CPD in a well-established PCIS... Sample PDF
Nursing Documentation in a Mature EHR System
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Chapter 7
Sisira Edirippulige, Anthony C. Smith, Mark Bensink, Nigel R. Armfield, Richard Wootton
Nurses play a pivotal role in the provision of healthcare. Home telehealth, the use of information and communication technologies to deliver and... Sample PDF
Nurses and Telehealth: Current Practice and Future Trends
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Chapter 8
Mary D. Oriol, Gail Tumulty
This chapter presents a theoretical framework and research base for the successful transition of an established Master of Science in Nursing program... Sample PDF
Successful Online Teaching and Learning Strategies
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Chapter 9
Virginia Plummer
This chapter is about the major policy issue of nursing resource allocation for hospitals. Health service executives have different views about... Sample PDF
Shaping Funding Policy for Nursing Services
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Chapter 10
Elizabeth M. Borycki, Andre W. Kushniruk, Shigeki Kuwata, Hiromi Watanabe
A range of new technologies/information systems are increasingly being used by nurses in healthcare organizations. These technologies/information... Sample PDF
Simulations to AssessMedication Administration Systems
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Chapter 11
Peter Jones
This chapter explores the potential of a conceptual framework – Hodges’ model – both as a socio-technical structure and means to explore such... Sample PDF
Socio-Technical Structures, 4Ps and Hodges' Model
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Chapter 12
Beth Perry Mahler, Margaret Edwards
Teaching nursing online requires teachers to purposefully use strategies that facilitate the development of virtual learning communities. The... Sample PDF
Strategies for Creating Virtual Learning Communities
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Chapter 13
Roberta Cuel, Roberta Ferrario
In this chapter a case study is presented, in which the ethnomethodological approach is used to analyze the impact of the implementation of an... Sample PDF
The Impact of Technology in Organizational Communication
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Chapter 14
Boris A. Kobrinsky, Nikolay V. Matveev
Telemedicine, or distant medical consultations using communication via electronic networks, is gradually becoming a standard of medical care... Sample PDF
The Roles of a Nurse in Telemedical Consultations
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Chapter 15
Daniel Carbone
The purpose of this chapter is to broadly discuss the need for enhanced evidence-based medicine (EBM) by nurses in the context of rural Australia... Sample PDF
The Role of EBM and Nursing Informatics in Rural Australia
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Chapter 16
Maureen Farrell
The use of mobile technologies in nursing education is rapidly increasing. Handheld computers are the most frequently used of these technologies as... Sample PDF
Use of Handheld Computers in Nursing Education
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Chapter 17
Elizabeth Rogerson, Linda Martindale, Carolyn Waltz
This chapter addresses issues relating to nursing informatics as used and applied in nursing education. This includes the use of information... Sample PDF
Using Information Technology in Nursing Education
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About the Contributors