The impact of computerized clinical decision support on diagnostic accuracy in nurse practitioners
MaryJo Vetter, MS, RN, ANP, GNP, DNP
- Sigma Affiliation
- Kappa Eta
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Top Visiting Cities
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Vetter, MaryJo by View
Popular Works for Vetter, MaryJo by Download
Session presented on Friday, July 25, 2014:
Clinical decision support (CDS) at the point of care is an evidence based intervention that has demonstrated incremental positive impact on quality of health care delivery over the past two decades. CDS information technologies help close the gap between healthcare provider knowledge and performance. CDS systems offer the potential to improve overall care safety, foster evidence based practice, optimize cost effectiveness and reimbursement for care, enhance patient education, and meet regulatory reporting requirements. CDS systems have been studied extensively and identified as an evidence based intervention that can positively impact practitioner performance in the areas of medication prescription, preventive care, disease management and diagnostic accuracy. This practice improvement project tested the impact of a newly acquired electronic clinical decision support system on diagnostic accuracy among nurse practitioners (NPs) functioning in a community based setting. Nurse practitioners delivering primary care in a home visiting practice are especially vulnerable to lack of knowledge support as they are mobile in the community and often feel isolated from peers and experts who can support clinical decision making. A CDS accessed via wireless broadband was viewed as a means to assist these clinicians to deliver care based on best practice recommendations obtainable via laptop or smartphones at the time of the patient encounter. To ensure adoption of electronic decision support systems, the approach to integration is best accomplished by involving end-users throughout the process. In addition to a pilot group of NPs who were representatives of the workforce, other organizational stakeholders were engaged to provide tangible support and necessary resources for successful adoption of this innovation in practice. A structured conceptual model of Evidence Based Practice Improvement (EBPI) enhanced with elements of the Promoting Action on Research Implementation in Health Sciences (PARIHS) framework was used to guide the development, implementation and evaluation of the improvement initiative and ultimately informed decision making about CDS dissemination strategies for the entire practice. Using an implementation science approach helped illuminate the internal and external evidence that informed parameters of the work and elicited both patient and clinician input in the process. Attention to the culture of the practice setting including leadership attributes and availability of project evaluation support defined the local context of the improvement effort. The nature of the facilitation required to ensure adoption of the CDS system was designed to be flexible based on the nature of the evidence, the expectations of stakeholders and the purpose of this evidence based practice change. Data collection was comprised of small tests of change (Plan, Do, Study, Act cycles) at the local practice level. Results informed refinement of CDS implementation processes that facilitated improvement in the correctness of medical diagnosis and appropriateness of substantiating clinical documentation over time. Clinician volunteers participated in vendor demonstrations and selection of the CDS system for the practice. A baseline chart audit was conducted using an audit tool that sought to identify that the primary diagnosis accurately reflects the current, most significant reason for the clinical encounter and that the secondary diagnoses are identified and substantiated in documentation found in the review of systems, history of present illness, diagnostic tests and physical examination. Clinical documentation elements must be linked to the chosen ICD-9 code which was expected to be of the highest diagnostic specificity. After training on the CDS system, charts of each participant were audited for the next three months to assess the impact of the CDS system availability on diagnostic accuracy. After several improvement cycles produced acceptable diagnostic accuracy results on chart audit, a focus group with the pilot NPs was conducted to determine the level of satisfaction with the CDS system and input on CDS system dissemination strategies to promote integration of decision support systems across the practice. In this practice setting, use of a CDS system by nurse practitioners was effective in impacting the outcome of diagnostic accuracy. Qualitative and quantitative data informed multiple strategies to guide ongoing improvement efforts aimed at sustaining long term results.
International Nursing Research Congress, 2014 Theme: Engaging Colleagues: Improving Global Health Outcomes. Held at the Hong Kong Convention and Exhibition Centre, Wanchai, Hong Kong
Items submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository.
|Review Type||Abstract Review Only: Reviewed by Event Host|
Clinical Decision Support;
Evidence Based Practice
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Showing items related by title, author, creator and subjects.
Healthy work environment best practices: Supporting leaders in evidence-based management decision making towards clinical nursing excellence Bajnok, Irmajean; White, Sara; Pallas, Linda O'Brien (2012-01-11)Healthy work environments are a critical component of quality patient care, nurse satisfaction, and organizational effectiveness. In an attempt to provide supports for those in leadership positions to enable evidence-based ...
Boswell, Carol; Long, JoAnn D.; Ashcraft, Alyce S.; Cannon, Sharon B.; DiVito-Thomas, Pamela; Delaney, Terry M.This project investigated the impact of self-efficacy on EBP knowledge and utilization by registered nurses. The presentation will present the results from the study completed.
Lee-Riggins, Andrea (2017-12-01)Providing anticoagulation therapy safely is a Joint Commission National Patient Safety Goal that can impact the safety of patients when performed incorrectly. The Nursing Professional Development Generalist and Informatics ...
Empowering nursing students at the Faculte des Sciences Infirmieres de Leogane (FSIL) to promote evidence-based practice in Haiti France, Marie-Carole (2014-11-17)Session presented on Sunday, July 27, 2014: Purpose: Nursing research is considered one of the most important courses in nursing curricula to prepare baccalaureate-nursing students for evidence-based practice. The purpose ...
Personal digital assistants: Their influence on clinical decision-making and the utilization of evidence-based practice in a baccalaureate nursing students Gorelick, Carol S.During the last decade, the advent of the personal digital assistant (PDA) and the development of clinical software specific to nursing practice have changed the way that many nurses manage information and workload. More ...