NR 599 Week 5 Discussion Clinical Decision Support Systems

NR 599 Week 5 Discussion Clinical Decision Support Systems

NR 599 Week 5 Discussion Clinical Decision Support Systems

The clinical decision support systems (CDSS) are computer-based programs that analyze data within EHRs and give prompts and reminders to help health care providers in implementing evidence-based clinical guidelines at the point of care. They are primarily utilized at the point-of-care, for providers to combine their knowledge with information or suggestions provided by the system (Sutton et al., 2020). It is aimed at improving healthcare delivery by facilitating medical decisions with targeted clinical knowledge, patient information, and other health information. The purpose of this assignment is to explore the pros and cons of the CDSS.

PROS	CONS
Promotes patient safety.The CDSS has alerts that inform the clinician of potential adverse drug events that may transpire with a particular drug prescribed to a patient.Medication-related CDS tools also help to lower medication errors thus promoting patient safety.	The CDSS is seen as a threat to clinicians’ clinical autonomy.Clinicians feel threatened by the clinical reminders, which elicit fear that one is losing autonomy and freedom of choice in the presence of the CDSS (Khairat et al., 2018).In addition, clinicians may develop the perception that the CDSS is meant to replace or degrade their clinical roles.
Lowers the rate of misdiagnosis.The CDSS includes computerized clinical guidelines and diagnostic support that help clinicians in making clinical diagnoses. Thus reduces the chances of misdiagnosing patients.	CDSS is expensive to adopt, maintain, and support.The expenses associated with purchasing and maintaining the CDSS locks out some facilities from adopting it.
Improves efficiency of patient care delivery.The CDSS analyzes data within the EHR. As a result, it provides prompts and reminders that assist health care providers in implementing evidence-based clinical guidelines at the point of care, thus improving efficiency in delivering care (Khairat et al., 2018).The CDSS also offer accurate diagnosis and dosage, which saves time.	The CDSS is associated with alert fatigue.Not every alert made by CDSS is usually correct.This means that clinicians might struggle with alert-related fatigue. Besides, there are always some possibilities of low-value prompts and alerts (Khairat et al., 2018).
Increased quality of care and enhanced health outcomes.The CDSS provides information on treatment protocols, prompts questions on medication adherence, and provides tailored recommendations for health behavior changes (Khairat et al., 2018).This improves the quality of care provided to patients, especially, those with chronic illnesses and enhances their health outcomes.	Failure to detect medication errors.If the CDSS is not implemented correctly, it may fail to identify medication errors, which can puts patients at risk (Sutton et al., 2020).

Clinical Patient and Scenario

A male adult patient comes to the psychiatric clinic with a severely elevated mood and symptoms suggesting mania. The patient’s relative mentions that he usually gets episodes of severely elevated mood whereby he is overactive. However, these periods last for one to two weeks, and the patient gets into a depressed mood. The CDSS, in this case, will be used to ensure that the PMHNP has made the correct psychiatric diagnosis of Bipolar disorder through the computerized DSM V in the system, which will lower the possibility of a misdiagnosis. In addition, the CDSS automated clinical guidelines will be used to identify the recommended medications to prescribe to a patient based on his age and severity of psychiatric symptoms. The CDSS will influence the drug prescribed based on the potential adverse drug events that the system will alert the PMHNP for each drug option. The drug with the least side effects and greatest benefit will be selected for this patient.

 References

Khairat, S., Marc, D., Crosby, W., & Al Sanousi, A. (2018). Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis. JMIR medical informatics, 6(2), e24. https://doi.org/10.2196/medinform.8912

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

Purpose

The ideas and beliefs underpinning the discussions guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Contribute level-appropriate knowledge and experience to the topic in a discussion environment that models professional and social interaction (CO4)

Actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty (CO5)

Requirements:

Post a written response in the discussion forum to EACH threaded discussion topic:

This week we learned about the potential benefits and drawbacks to clinical decision support systems (CDSSs). Create a “Pros” versus “Cons” table with a column for “Pro” and a separate column for “Con”. Include at least 3 items for each column. Next to each item, provide a brief rationale as to why you included it on the respective list.

The primary goal of a CDSS is to leverage data and the scientific evidence to help guide appropriate decision making. CDSSs directly assist the clinician in making decisions about specific patients. For this discussion thread post, you are to assume your future role as an APN and create a clinical patient and scenario to illustrate an exemplary depiction of how a CDSS might influence your decision. This post is an opportunity for you to be innovative, so have fun!

Adhere to the following guidelines regarding quality for the threaded discussions in Canvas:

Application of Course Knowledge: Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings.

Scholarliness and Scholarly Sources: Demonstrates achievement of scholarly inquiry for professional and academic decisions using valid, relevant, and reliable outside scholarly source to contribute to the discussion thread.

Writing Mechanics: Grammar, spelling, syntax, and punctuation are accurate. In-text and reference citations should be formatted using correct APA guidelines.

Direct Quotes: Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.

For each threaded discussion per week, the student will select no less than TWO scholarly sources to support the initial discussion post.

PROS to CDSS	CONS to CDSS
Patient safety – The most important reason CDS is useful and the underlying reason it is available is to keep patients safe and assist providers in making the right decisions for care. There is a multitude of functions in place by CDS such as order set, templates, diagnosis support, medication correctness etc. which allow for patient safety.	Alarm fatigue – multiple patients on a workload can cause alarm fatigue to the end user. Often times CDS flags can be overlooked to save time or not seen by the user which can cause messages to not be useful.
Critical care “hard stop” for processes – This system is helpful in high pressure/critical care moments where quick action is needed for medication administration, for example. If the end user is completing the process using CDS systems and following protocol it is able to stop the process and alert the provider of a critical missing step, wrong medication, or other options available for care to be completed before the system will return from alert mode	Human inaction errors – This assumes that humans will make the right choices when a notification alarm is seen. The use of CDS in the workplace is only as useful as the end users ability to competently or ethically follow the prompts that the CDS message is stating needs to be completed.
Predictive texts/templates – Are useful when creating a common language needed for documentation and may cut down on the amount of time providers spend documenting visits, assessments or other documentation needs in the EHR system	No grey areas in the system – The CDS is black and white and can only have set parameters set, such as BP readings, which may or may not be helpful for a patient with chronic HTN who baseline BP reading is higher than the standard “normal” This can lead to alarm fatigue and errors for treatment if there is a reading that is outside of the parameters and flags continuously even though it may not be a reading that is truly hypertensive.

Utilizing CDSS to monitor, collect and review data and interventions in wound care could be pivotal in the monitoring, reduction and appropriate care for persons with wound care needs. Utilizing the CDSS would provide a snapshot on the measurements of the wound and progression of healing or non-healing. The system can also provide a list of possible interventions to be used for the type of wound, location and based off of clinical standards of treatment. Research conducted by Chunmei, Hualing and Haihua (2018) showed that implementing CDS with wound care in a hospital setting reduced the incidence of pressure ulcers by almost 5% in one year. This research utilized CDS for reminders for repositioning of patients and not direct care of wounds. We as providers should recognize the importance of wound care prevention as part of the wound care protocols CDSS can assist with. Often times the decisions needed to make regarding treatment of chronic wounds are complex and we as providers rely on our own experiences, instead of clinical evidence-based tools, for treatment recommendations (Schaarup et al., 2018). Having increased access to CDSS for wound care alleviates the pressure placed on the provider for wound care options and allows access to EBP and protocols for treatment options (Schaarup et al., 2018). Mebrahtu et al. (2021) suggest that widening the base of available CDS technologies that incorporate more in- depth protocols, clinical decision options and broadening the medical knowledge that the system includes will only strengthen the CDS abilities to assist providers with useful and more efficient tools of care.

In a perfect world situation, a patient, Mrs. Smith, a 67 year old female with 20 year history of diabetes comes into the clinic with a stage 3 ulcer on her right foot. The provider would take measurements, input past wound care that has not helped and possibly take photos of the unhealing ulcer. The CDSS would them take entered data and populate an evidence-based protocol and wound care options for her. The care options would also provide nutritional intake suggestions for increased wound healing and also blood sugar level guidelines. The provider would then be able to select the appropriate level of intervention and wound care. The provider would also have a list of possible in-home wound care providers to assist Mrs. Smith with wound care at home and make sure she has the support needed in the community to promote healing.  The system would also generate suggested healing times based on care received and nutritional intake so Mrs. Smith can understand the diligence and time healing can take. Lastly a list of pain management would be populated to help manage the pain possibly being generated by the wound and what she can safely take before wound care treatments.

References

Chunmei, R., Hualing, H., & Haihua, Z. (2018). Design and Application of Nursing CDSS Based on Structured EMR. Studies in Health Technology and Informatics, 250, 238–239. https://doi.org/10.3233/978-1-61499-872-3-238Links to an external site.

Mebrahtu, Bloor, K. K., Ledward, A. A., Keenan, A.-M. A.-M., Andre, D. D., Randell, R. R., Skyrme, S. S., Yang, H. H., King, H. H., & Thompson, C. A. C. A. (2021). Effects of computerised clinical decision support systems (CDSS) on nursing and allied health professional performance and patient outcomes. Cochrane Database of Systematic Reviews, 2021(3). https://doi.org/10.1002/14651858.CD014699Links to an external site.

Schaarup, C., Pape-Haugaard, L., & Hejlesen, O. (2018). Models Used in Clinical Decision Support Systems Supporting Healthcare Professionals Treating Chronic Wounds: Systematic Literature Review. JMIR Diabetes, 3(2), e11–e11. https://doi.org/10.2196/diabetes.8316

Scholarly Sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal.  You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article.  The following sources should not be used: Wikipedia, Wikis, or blogs.  These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality.  For example, the American Heart Association is a .com site with scholarship and quality.  It is the responsibility of the student to determine the scholarship and quality of any .com site.  Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years.  Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.