Nurse Cognition, Decision Support, and Barcode Medication Administration: A Conceptual Framework for Research, Practice, and Education

2021 ◽  
Vol 39 (12) ◽  
pp. 1041-1041
Keyword(s):  
Decision Support ◽  
Conceptual Framework ◽  
Medication Administration ◽  
Research Practice

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

A conceptual framework for a multi-criteria decision support tool to select technologies for resource recovery from urban wastewater

2021 ◽  
Vol 300 ◽  
pp. 113608
Author(s):  
Seda Sucu ◽  
Maria O. van Schaik ◽  
Ramazan Esmeli ◽  
Djamila Ouelhadj ◽  
Timothy Holloway ◽  
...  
Keyword(s):  
Decision Support ◽  
Conceptual Framework ◽  
Decision Support Tool ◽  
Resource Recovery ◽  
Urban Wastewater ◽  
Support Tool

From Hydrological Models to Policy-Relevant Decision Support Systems (DSSs)

2010 ◽  
pp. 81-123
Author(s):  
Mukhtar Hashemi ◽  
Enda O’Connell
Keyword(s):  
Decision Support ◽  
Conceptual Framework ◽  
Decision Support Systems ◽  
Information And Communication Technologies ◽  
Support Systems ◽  
Process Models ◽  
Study Approach ◽  
Political Sciences ◽  
Computing Platforms ◽  
The 1960S

Since the advent of modern computing platforms in the 1960s and despite scepticisms and uncertainties, modelling systems have become indispensable tools in water resources management. They have been postulated to support the decision-making process and hence the term decision support systems (DSSs) emerged. Hydroinformatics is a recent term compared to computational hydraulics and hydrological watershed modelling but it is an encompassing cross disciplinary concept covering hydraulics, hydrology, environmental engineering, socioeconomic and political (institutional) disciplines and it uses information and communication technologies to provide evidences for decision-makers. The aims of this chapter are two fold: (a) to review the current trends in modelling activities based on historical precedence; and (b) to present a conceptual framework for development of a comprehensive DSS using a case study approach. Hence, this chapter consists of three main parts: (1) a historical account of the DSSs, starting from early single process models to current integrated comprehensive basin-wide DSSs; (2) having established a historical perspective, case studies from Iranian experience are presented to outline a methodological (conceptual) framework for developing a comprehensive DSS. Examples of policy-relevant DSSs from the latest research are also presented. It is concluded that there would be a greater demand in the future to develop integrated policy-relevant DSSs comprising not only the technical and engineering aspects but to include the socioeconomic and political sciences as well. The new DSSs should be able to deal with uncertainties such as climate change (i.e. to have scenario analysis capabilities), be able to compare different management strategies using multi-criteria analysis tools and to include socio-economic, institutional and environmental sustainability criteria.

Tailorable Technologies for Improving Business Intelligence Systems

2021 ◽  
pp. 560-575
Author(s):  
Shah J. Miah
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Conceptual Framework ◽  
Business Intelligence ◽  
Cost Effective ◽  
Business Owners ◽  
Business Intelligence Systems ◽  
Effective Operation

The Australian farm-based businesses can be benefited from specially designed applications for cost-effective operation while maximizing profits to survive in economic and environmental crises. For decision support, existing business intelligence systems (BIS) approaches scarcely deal with specific user's provisions to adjust changing situations in decision making, without extra technical exertions. In this chapter, the authors describe a conceptual framework of tailorable BIS solution that is based on case study findings in that the highlighted requirements are relevant to address changing situations through enhancing end user's engagement. The activities of end user's engagement supported through the use of tailorable features that reinforce a shift from the traditional BIS process to a new provision where business owners can actively involve in adjusting their features to their decision support.

Accessing Knowledge, Information and Resources for Planning and Spatial Decision Support

2012 ◽  
Vol 1 (1) ◽  
pp. 90-97
Author(s):  
Naicong Li
Keyword(s):  
Decision Support ◽  
Conceptual Framework ◽  
Planning Process ◽  
Relevant Information ◽  
Spatial Decision Support ◽  
Knowledge Domains ◽  
Problem Types ◽  
Standard Set ◽  
Planning Problems ◽  
Knowledge Portal

To help synthesize and systematically organize the information, knowledge and resources for spatial decision support (SDS), and to help researchers and practitioners engaged in an actual planning process find relevant information and resources for solving their specific planning problems, the SDS Consortium and University of Redlands have developed a conceptual framework for SDS and a collection of SDS resources, hosted on the SDS Knowledge Portal. The conceptual framework includes a set of defined, inter-connected concepts pertaining to planning and spatial decision support, such as planning and decision problem types, application domains, knowledge domains and planning process including phases and steps. This conceptual framework is further used to organize a representative set of SDS resources, such as planning process workflows, methods, tools and models, data sources, case studies, literature, and so forth. The SDS Knowledge Portal facilitates learning of SDS and accessing SDS resources, promotes semantic clarity by adopting a common vocabulary for the user community, and promotes interoperability among SDS resources by using a standard set of concepts to define and classify these resources.

scholarly journals Design Challenges for Electronic Medication Administration Record Systems in Residential Aged Care Facilities

2014 ◽  
Vol 05 (04) ◽  
pp. 971-987 ◽  
Author(s):  
E. Lehnbom ◽  
K. Oliver ◽  
A. Georgiou ◽  
C. Rowe ◽  
T. Osmond ◽  
...  
Keyword(s):  
Decision Support ◽  
Medication Administration ◽  
Aged Care ◽  
Residential Aged Care ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Design Challenges ◽  
Roll Out ◽  
Electronic Medication Administration

SummaryIntroduction: Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements.Methods: A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system.Results: The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows.Discussion: Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.Citation: Tariq A, Lehnbom E, Oliver K, Georgiou A, Rowe C, Osmond T, Westbrook J. Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation. Appl Clin Inf 2014; 5: 971–987http://dx.doi.org/10.4338/ACI-2014-08-RA-0062

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