Nursing Accuracy Improves with Embedded Clinical Decision Support Tools
Andrea Lee-Riggins, DNP, APRN-CNS, CCNS, CCRN
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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 Nurse surmised that by incorporating clinical decision support (CDS) tools into nursing workflows during EMR training, nursing accuracy for PTT monitoring and timing, and Heparin nomogram calculations may improve; which would lead to improved nurses’ responsiveness in preventing harm to patients caused by: complex nomograms, insufficient PTT monitoring, and inconsistent EMR workflow knowledge. The ADPIE (Assessment, Diagnosis, Planning, Implementation, and Evaluation) process is the strategy that was utilized. After observing current EMR and nursing workflows at the unit level during Heparin administration (Assessment), it was determined that the EMR tools that were developed for the nurses, were inadequately and inconsistently utilized by the nurses. A Heparin simulation incorporating the CDS tools (e.g. Worklist, Sidebar Report, and hyperlinked Heparin calculators) was constructed and scripted for standardization and a 1-hour simulation session, which occurred over a 1 week period in April 2016, was mandated for all in-patient nurses (Planning and Implementation). The outcome of this educational activity demonstrated an improvement for PTT timing from 67% to 80% and Heparin nomogram calculation accuracy improved from 51% to 100%. In addition, 87% of the nurses demonstrated accurate independent application of the EMR workflow with the second validation scenario and many verbally recommended this strategy for all new hire nurses during hospital orientation (Evaluation).
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