Driving patient outcomes through clinical decision support systems and nurse-directed protocols
View File(s)
Visitor Statistics
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Country | Visits |
---|
Top Visiting Cities
City | Visits |
---|
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Glasofer, Amy by View
Title | Page Views |
---|
Popular Works for Glasofer, Amy by Download
Title | Downloads |
---|
View Citations
Citations
Session presented on Tuesday, November 10, 2015:
Background: Nurse-directed catheter removal protocols (NDCRPs) are a recommended strategy to promote prompt removal of unnecessary urinary catheters, thus reducing patient risk for catheter associated urinary tract infection (CAUTI). However, implementation of NDCRPs has not been widespread, and adoption of protocol recommendations is even lower. Clinical decision support systems (CDSSs) have the potential to improve patient outcomes by delivering evidence-based guidance to frontline nurses in the course of their workflow. This study explored the effect of a CDSS promoting NDCR on the rates of NDCR, CAUTI, and urinary catheter utilization at a mid-sized community hospital. Additionally, data from open-ended questionnaires and individual interviews were analyzed to understand why nurses might not remove a urinary catheter despite meeting NDCRP criteria, and factors limiting the impact of the CDSS.
Sample: patients with urinary catheters eligible for NDCR for 4 months before and 4 months after implementation of a CDSS linked to the protocol for NDCR (Phase 1 n=103, Phase 2 n=100); Nurses on inpatient units who responded to an open-ended questionnaire (n=30) and participated in validation of the analysis (n=7). Data Collection/Analysis: 1) Retrospective comparison of NDCR (chi-square analysis), CAUTI, and urinary catheter utilization rates (comparison of rates) before and after implementation of a CDSS linked to the NDCR protocol 2) Thematic analysis of open-ended questionnaire responses describing nurses' experiences with the protocol for NDCR, and CDSS.
Results: Implementation of the CDSS resulted in significantly increased NDCR (Phase 1=42%, Phase 2=76%, X 2=19.6; df=1, p<.001) but no significant difference in catheter utilization rate (Phase 1=.26/patient day, Phase 2=.26/patient day; p=.953) or CAUTI rate (Phase 1=.69/1,000 catheter days, Phase 2=.25/1,000 catheter days; p=.362). Analysis of the open-ended responses resulted in identification of 3 main themes which both enhance and detract from the capacity of a NDCR protocol and CDSS to impact patient outcomes: (a) professional values with the subthemes of autonomy, accountability, and high-quality care; (b) avoidance of conflict in professional relationships; and (c) ease of workflow.
Discussion: This presentation will be concentrated on findings of the qualitative component of this study offering insight into why the protocol and CDSS did not result in improved patient outcomes. Specifically, discussion will focus on nurses' comfort with autonomy granted by nurse-directed protocols and how this may limit the efficacy of such protocols. In this qualitative sample, half of respondents commented that they were not comfortable to remove the catheter without minimally consulting with the provider, or even having a provider order. The discomfort seemed to stem from the overriding belief that nurses need an order for everything, despite knowledge of the standing protocol. Additionally, there was fear that a catheter would have to be re-inserted in which case the patient or physician might be angry with them. While other research has indicated that discomfort with autonomy may be a limiting factor in nurse-directed protocols, this study generates an understanding of the underlying issues. The discussion will offer recommendations for addressing the culture of safety to promote nurse autonomy in order to increase adoption of evidence-based practice and improve patient outcomes.
43rd Biennial Convention 2015 Theme: Serve Locally, Transform Regionally, Lead Globally.
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, unless otherwise noted.
Type | Presentation |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Evidence-based Practice; Nursing Informatics; Professional Practice |
Name | 43rd Biennial Convention |
Host | Sigma Theta Tau International |
Location | Las Vegas, Nevada, USA |
Date | 2015 |
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.
Related items
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 ... -
Elements of a decision support system for chief nurse executives
Barton, Amy J.The objective of this nursing informatics research was to identify data elements for a decision support system (DSS). The specific purposes were to (a) prioritize issues for strategic planning decisions that are expected ... -
Impact of real-time prediction model-enhanced clinical decision support systems on nursing sensitive patient outcomes: A review of the literature
Jeffery, Alvin Dean (2016-03-17)Session presented on Saturday, July 25, 2015: Background: The popularity of 'big data' along with an increasing capacity for real-time predictive analytics to augment clinical decision support systems (CDSS) within electronic ... -
Standardizing the collection of clinical outcomes to support evidence-based practice
White, Peggy Ann (2016-03-21)Session presented on Monday, November 9, 2015: Measuring and improving the quality of health care delivery is one of the most critical challenges facing health care clinicians and decision-makers. In the Canadian province ... -
Driving evidence-based practice through remote and/or mobile applications
Tharp-Barrie, Kim; Williams, Tracy (2017-07-18)Purpose: The pilot study investigated the efficacy of a mobile application designed to facilitate critical thinking and clinical reasoning at the bedside, specifically related to nurse-sensitive quality indicators and core ...