scholarly journals A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines

2021 ◽  
Author(s):  
Tessa Jaspers ◽  
Marjolijn Duisenberg-van Essenberg ◽  
Barbara Maat ◽  
Marc Durian ◽  
Roy van den Berg ◽  
...  
Keyword(s):  
Decision Support ◽  
Venous Thromboembolism ◽  
Clinical Decision Support ◽  
Guideline Adherence ◽  
Intervention Group ◽  
Clinical Decision ◽  
Multifaceted Intervention ◽  
Annual Number ◽  
Post Intervention ◽  
Mobile Phone Application

AbstractBackground Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low. Objective To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented. Setting A Dutch general teaching hospital. Method A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients. Main outcome measure Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements. Results 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4 to 82.4% (OR 4.78; 95%CI 2.37–9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5 to 84.3% (OR 2.46; 95%CI 1.31–4.62), resulting in the potential prevention of ± 261 venous thromboembolisms per year. Conclusions Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence.

scholarly journals A Multifaceted Clinical Decision Support Intervention to Improve Adherence to Thromboprophylaxis Guidelines 

2021 ◽  
Author(s):  
Tessa Jaspers ◽  
Marjolijn Duisenberg-van Essenberg ◽  
Barbara Maat ◽  
Marc Durian ◽  
Roy van den Berg ◽  
...  
Keyword(s):  
Decision Support ◽  
Venous Thromboembolism ◽  
Clinical Decision Support ◽  
Guideline Adherence ◽  
Intervention Group ◽  
Clinical Decision ◽  
Multifaceted Intervention ◽  
Annual Number ◽  
Post Intervention ◽  
Mobile Phone Application

Abstract Background: Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low.Objective: To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented.Setting: A Dutch general teaching hospital.Method: A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients.Main outcome measure: Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements.Results: 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4% to 82.4% (OR 4.78; 95%CI 2.37-9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5% to 84.3% (OR 2.46; 95%CI 1.31-4.62), resulting in the potential prevention of ±261 venous thromboembolisms per year.Conclusions: Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence.

scholarly journals Sinusitis Treatment Guideline Adherence in the e-visit Setting

2016 ◽  
Vol 07 (02) ◽  
pp. 299-307
Author(s):  
Dang Tran ◽  
Bonnie Westra ◽  
Kevin Smith
Keyword(s):  
Quality Improvement ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Guideline Adherence ◽  
Clinical Guideline ◽  
Clinical Decision ◽  
Care Providers ◽  
Post Intervention ◽  
Improvement Project ◽  
Time Period

SummaryStudies demonstrate poor guideline adherence by health care providers for the treatment of upper respiratory infections, particularly acute bacterial rhinosinusitis (ABRS), in the appropriate prescribing of antibiotic medications.The purpose of this quality improvement project was to evaluate the effect of implementing interventions for improving adherence to a clinical practice guideline for the management of ABRS for patients treated in the e-visit setting. Interventions included: providing a report to providers of their adherence to the ABRS clinical guideline prior to the intervention, providing updated education on the ABRS guideline, and implementing a clinical decision support system reminder.A pre and post intervention evaluation design was used. Data were obtained from a retrospective electronic health record (EHR) data extract of all 316 diagnoses for ABRS in the preintervention 2-month time period and all 368 diagnoses of ABRS in the post-intervention 2-month time period. A review of the structured clinical data elements was performed to determine whether the provider adhered to the clinical guideline, meaning that only patients meeting the criteria for ABRS were to receive an antibiotic prescription.The interventions resulted in a 3.3% improvement in adherence to the ABRS clinical guideline from 95.25% adherence pre-intervention to 98.4% post-intervention. These results demonstrated that the use of an educational intervention and clinical decision support resulted in improved adherence to the ABRS clinical guideline in the e-visit setting. The implications for practice could be significant in that these quality improvement interventions improve guideline adherence and reduce unnecessary prescribing of antibiotics.

scholarly journals Effect of Web-based Clinical Decision Support Systems on Adherence to Venous Thromboembolism Prophylaxis guideline among ICU Nonsurgical Patients: A Prospective Before and After Study

2021 ◽  
Author(s):  
Mehrdad Karajizadeh ◽  
Farid Zand ◽  
Roxana Sharifian ◽  
Afsaneh Vazin ◽  
Najmeh Bayati
Keyword(s):  
Decision Support ◽  
Venous Thromboembolism ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
P Value ◽  
Post Intervention ◽  
Vte Prophylaxis ◽  
Nonsurgical Patients

Abstract Background and objective: There is a gap between expert recommendations and clinical practice in (Venous Thromboembolism) VTE prophylaxis among nonsurgical patients worldwide. Rate of adherence to evidence-based practice is inadequate in the nonsurgical population. Therefore, this study aimed to determine The effect of Clinical Decision Support Systems(CDSS) on the use of the appropriate VTE Prophylaxis in Nonsurgical Patients in the Intensive Care Unit (ICU).Method: We conducted a cross-sectional study (pre and post-implementation CDSS for recommendation VTE prophylaxis order set) to analyze the effect of the CDSS within CPOE on the appropriate VTE prophylaxis in three ICUs of the Nemazee hospital (before intervention from 20 April 2020, to 21 November 2020 and post-intervention duration form 7 April 2021, to 9 July 2021). The pre-intervention and post-intervention phase samples comprised 175 and 27 patients, respectively. P-value is less than 0.05 was considered a significant level. All statistical analysis was performed by SPSS version 24.Results: Adherence to VTE prophylaxis guidelines after introduced CDSS for recommendation VTE prophylaxis within CPOE system in nonsurgical patients in ICUs increase from 48.6% to 77.8% (p-value<01). However, mortality rate (pre-intervention 13.80% vs post-intervention 14.80%(p-value=0.88)) and means of length of stay (pre-intervention 13.66 vs post intervention13.63(p-value=0.49)) in ICU have not significantly change after introduced CDSS for recommendation VTE prophylaxis order sets.Conclusion: The results indicate that the CDSS for recommendation VTE prophylaxis within CPOE improves adherence to VTE prophylaxis in nonsurgical patients at ICUs, which assist provider to select the most tailored VTE prophylaxis. Further study needs to evaluate implemented CDSS for recommendation VTE prophylaxis in nonsurgical patients at a province and national level.

scholarly journals Quality of the documentation of the Nursing process in clinical decision support systems

2021 ◽  
Vol 29 ◽  
Author(s):  
Neurilene Batista de Oliveira ◽  
Heloísa Helena Ciqueto Peres
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
P Value ◽  
Nursing Process ◽  
Post Intervention ◽  
Quasi Experimental ◽  
Process Documentation

Objective: to compare the quality of the Nursing process documentation in two versions of a clinical decision support system. Method: a quantitative and quasi-experimental study of the before-and-after type. The instrument used to measure the quality of the records was the Brazilian version of the Quality of Diagnoses, Interventions and Outcomes, which has four domains and a maximum score of 58 points. A total of 81 records were evaluated in version I (pre-intervention), as well as 58 records in version II (post-intervention), and the scores obtained in the two applications were compared. The interventions consisted of planning, pilot implementation of version II of the system, training and monitoring of users. The data were analyzed in the R software, using descriptive and inferential statistics. Results: the mean obtained at the pre-intervention moment was 38.24 and, after the intervention, 46.35 points. There was evidence of statistical difference between the means of the pre- and post-intervention groups, since the p-value was below 0.001 in the four domains evaluated. Conclusion: the quality of the documentation of the Nursing process in version II of the system was superior to version I. The efficacy of the system and the effectiveness of the interventions were verified. This study can contribute to the quality of documentation, care management, visibility of nursing actions and patient safety.

scholarly journals P036: A clinical decision support intervention to increase usage of probenecid in the ED

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S90-S90
Author(s):  
S. Dowling ◽  
E. Lang ◽  
D. Wang ◽  
T. Rich
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Soft Tissue ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Soft Tissue Infections ◽  
Post Intervention ◽  
Support Intervention ◽  
Intervention Phase ◽  
Decision Support Intervention

Introduction: In certain circumstances, skin and soft tissue infections are managed with intravenous (IV) antibiotics. In our center, patients initiated on outpatient IV antibiotics are followed up by a home parental therapy program the following day. A significant number of these patients require a repeat visit to the ED because of clinic hours. Probenecid is a drug that can prolong the half-life of certain antibiotics (such as cefazolin) and can therefore avoid a repeat ED visit, reducing health care costs and improve ED capacity. Our goal was to increase probenecid usage in the ED in order to optimize management of skin and soft tissue infections (SSTI) in the ED. The primary outcome was to compare the usage of probenecid in the pre and post-intervention phase. Secondary outcomes were to compare revisit rates between patients receiving cefazolin alone vs cefazolin + probenecid. Methods: Using administrative data merged with Computerized Physician Order Entry (CPOE), we extracted data 90 days pre- and 90 post-intervention (February 11, 2015 to August 11, 2015). The setting for the study is an urban center (4 adult ED’s with an annual census of over 320,000 visits per year). Our CPOE system is fully integrated into the ED patient care. The multi-faceted intervention involved modifying all relevant SSTI order sets in the CPOE system to link any cefazolin order with an order for probenecid. Physicians and nurses were provided with a 1 page summary of probenecid (indications, contra-indications, pharmacology), as well as decision support with the CPOE. Any patients who were receiving outpatient cefazolin therapy were included in the study. Results: Our analysis included 2512 patients (1148 and 1364 patients in the pre/post phases) who received cefazolin in the ED and were discharged during the 180 day period. Baseline variables (gender, age, % admitted) and ED visits were similar in both phases. In the pre-intervention phase 30.2% of patients received probenecid and in the post-intervention phase 43.0%, for a net increase of 12.8% (p=<0.0001). Patients who received probenecid had a 2.2% (11.4% vs 13.6%, p=0.014) lower re-visit rate in the following 72H. Conclusion: We have implemented a CPOE based clinical decision support intervention that demonstrated significant increase in probenecid usage by emergency physician and resulted in a decrease in ED revisits. This intervention would result in health care cost-savings.

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