Decision Support During Inpatient Care Provider Order Entry: The Vanderbilt Experience

2007 ◽  
pp. 215-248 ◽  
Author(s):  
Randolph A. Miller ◽  
L. Russell Waitman ◽  
Sutin Chen ◽  
S. Trent Rosenbloom
Keyword(s):  
Decision Support ◽  
Care Provider ◽  
Inpatient Care ◽  
Order Entry

scholarly journals The anatomy of decision support during inpatient care provider order entry (CPOE): Empirical observations from a decade of CPOE experience at Vanderbilt

2005 ◽  
Vol 38 (6) ◽  
pp. 469-485 ◽  
Author(s):  
Randolph A. Miller ◽  
Lemuel R. Waitman ◽  
Sutin Chen ◽  
S. Trent Rosenbloom
Keyword(s):  
Decision Support ◽  
Care Provider ◽  
Inpatient Care ◽  
Order Entry

scholarly journals Implementation Strategies of a Quality Improvement Initiative for Hospital-Acquired Clostridioides difficile Infection Prevention

2020 ◽  
Vol 41 (S1) ◽  
pp. s279-s280
Author(s):  
Nicole Lamont ◽  
Lauren Bresee ◽  
Kathryn Bush ◽  
Blanda Chow ◽  
Bruce Dalton ◽  
...  
Keyword(s):  
Decision Support ◽  
Focus Groups ◽  
Clinical Decision Support ◽  
Implementation Strategy ◽  
Clinical Decision ◽  
Medication Administration ◽  
Quality Improvement Initiative ◽  
Order Entry ◽  
Clostridioides Difficile ◽  
Number Of Patients

Background:Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea in hospitalized patients. Probiotics have been studied as a measure to prevent CDI. Timely probiotic administration to at-risk patients receiving systemic antimicrobials presents significant challenges. We sought to determine optimal implementation methods to administer probiotics to all adult inpatients aged 55 years receiving a course of systemic antimicrobials across an entire health region. Methods: Using a randomized stepped-wedge design across 4 acute-care hospitals (n = 2,490 beds), the probiotic Bio-K+ was prescribed daily to patients receiving systemic antimicrobials and was continued for 5 days after antimicrobial discontinuation. Focus groups and interviews were conducted to identify barriers, and the implementation strategy was adapted to address the key identified barriers. The implementation strategy included clinical decision support involving a linked flag on antibiotic ordering and a 1-click order entry within the electronic medical record (EMR), provider and patient education (written/videos/in-person), and local site champions. Protocol adherence was measured by tracking the number of patients on therapeutic antimicrobials that received BioK+ based on the bedside nursing EMR medication administration records. Adherence rates were sorted by hospital and unit in 48- and 72-hour intervals with recording of percentile distribution of time (days) to receipt of the first antimicrobial. Results: In total, 340 education sessions with >1,800 key stakeholders occurred before and during implementation across the 4 involved hospitals. The overall adherence of probiotic ordering for wards with antimicrobial orders was 78% and 80% at 48 and 72 hours, respectively over 72 patient months. Individual hospital adherence rates varied between 77% and 80% at 48 hours and between 79% and 83% at 72 hours. Of 246,144 scheduled probiotic orders, 94% were administered at the bedside within a median of 0.61 days (75th percentile, 0.88), 0.47 days (75th percentile, 0.86), 0.71 days (75th percentile, 0.92) and 0.67 days (75th percentile, 0.93), respectively, at the 4 sites after receipt of first antimicrobial. The key themes from the focus groups emphasized the usefulness of the linked flag alert for probiotics on antibiotic ordering, the ease of the EMR 1-click order entry, and the importance of the education sessions. Conclusions: Electronic clinical decision support, education, and local champion support achieved a high implementation rate consistent across all sites. Use of a 1-click order entry in the EMR was considered a key component of the success of the implementation and should be considered for any implementation strategy for a stewardship initiative. Achieving high prescribing adherence allows more precision in evaluating the effectiveness of the probiotic strategy.Funding: Partnerships for Research and Innovation in the Health System, Alberta Innovates/Health Solutions Funding: AwardDisclosures: None

scholarly journals Provider Feedback about Imaging Appropriateness by Using Scores from Order Entry Decision Support: Raw Rates Misclassify Outliers

Radiology ◽  
2015 ◽  
Vol 275 (2) ◽  
pp. 469-479 ◽  
Author(s):  
Chris L. Sistrom ◽  
Jeffrey B. Weilburg ◽  
Keith J. Dreyer ◽  
Timothy G. Ferris
Keyword(s):  
Decision Support ◽  
Order Entry ◽  
Imaging Appropriateness ◽  
Entry Decision

Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization

Transfusion ◽  
2015 ◽  
Vol 55 (7) ◽  
pp. 1628-1636 ◽  
Author(s):  
Gabriel S. Zuckerberg ◽  
Andrew V. Scott ◽  
Jack O. Wasey ◽  
Elizabeth C. Wick ◽  
Timothy M. Pawlik ◽  
...  
Keyword(s):  
Decision Support ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Order Entry ◽  
Computerized Provider Order Entry

Use of Imaging Appropriateness Criteria for Decision Support During Radiology Order Entry: The MGH Experience

2013 ◽  
pp. 123-141 ◽  
Author(s):  
Chris L. Sistrom ◽  
Jeffrey B. Weilburg ◽  
Daniel I. Rosenthal ◽  
Keith J. Dreyer ◽  
James H. Thrall
Keyword(s):  
Decision Support ◽  
Order Entry ◽  
Appropriateness Criteria ◽  
Imaging Appropriateness
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