How Well Do Computerised Decision Support Systems Cover Nursing Standards of Practice? A Literature Review

The use of computerized decision support systems (DSS) in nursing practice is increasing. However, research about who uses DSS, where are they implemented, and how they are linked with standards of nursing is limited. This paper presents evidence on users and settings of DSS implementation, along with specific nursing standards of practice that are facilitated by such DSS. We searched six bibliographic databases using relevant terms and identified 28 studies, each evaluating a unique DSS. Of these, 24 were used by registered nurses and 19 were implemented in short-term care units. Most of the DSS were found to facilitate nursing standards of assessment and intervention, however, outcome identification and evaluation were the least included standards. These findings not only highlight gaps in systems but also offer opportunities for further research development in this area.

Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

<b>Objective: </b>The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment (PPE) and reduce potential exposures during COVID-19. <p><b>Design and Methods:</b> We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion (CII) and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 ICU.<b></b></p> <p><b>Results: </b>All nine patients required mechanical ventilation and corticosteroids. Seventy six percent of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients.</p> <p><b>Conclusions: </b>A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion. </p>

Changes in anticoagulant prescription in a general hospital in 2008-2018

Aim. To study the structure of anticoagulant prescription in a general hospital to identify trends and contributing factors.Materials and methods. The study was conducted in an urban general hospital. According to retrospective retrieval from electronic health records, total 17,129 patients received anticoagulants from 2008 to 2018. Formal appropriateness of oral anticoagulants (OАС) prescriptions for 6,638 patients with atrial fibrillation (AF) was analyzed with CHA2-DS2-VASc score.Results. Appearance of recommendations for the direct oral anticoagulants (DOAC) prescription in clinical guidelines for venous thromboembolism (VTE) and AF management contributed to steady increase in the DOAC taking and decrease in the proportion of warfarin prescription. From 2011 to 2018, the proportion of patients with DOACs prescription increased from 1.7% to 81.5%. The most common indications for anticoagulant were ischemic stroke prevention in AF and VTE with mean rate 75.3% and 23.2%, respectively for the 2011-2018 period. Steady increase in low-molecular-weight heparin (LMWH) prophylactic prescriptions was also shown (Chi-square for linear trend=1340, df=1, p<0.0001). Since 2014, the prescription of LMWH in prophylactic doses increased dramatically, probably related to implementation of computerized decision support system (CDSS) for VTE prevention in the hospital.Conclusion. The study showed that in a general hospital anticoagulants were prescribed in 19% of hospitalized patient. Not only the new clinical recommendations based on the results of the recent studies on anticoagulants efficacy and safety (external factors), but also implementation standard operating protocols and CDSS, providing physicians current information about the relevant clinical recommendations (internal changes), could influence the appropriateness of anticoagulants prescription.

Validation of a Computerized Decision Support System To Review Pharmacotherapy Treatment: Scheduling Guidelines

Background In the pharmacotherapy review process, the pharmacist needs to list various information about the patient and the set of medications he will use, information that is never available at the point of care. Methods The aim of the study was to validate an intelligent information system, which was developed to assist the scheduling activity in the pharmacotherapy review process. The system used the concept of Genetic Algorithms. To validate it, appointments of hypothetical cases (ten) were made by the system and by human specialists. These schedules were qualitatively evaluated by pharmaceutical specialists with clinical and research experience in the pharmacotherapy review process. The degree of agreement between the assessments of the appointments carried out by the pharmaceutical specialists and by the system were measured using the Kappa index with a 95% confidence interval. Results In detecting errors, propositions, the system was able to identify 80% of errors, with human specialists identifying between 20% and 70% of errors. In relation to the general evaluation, the system obtained 87,3% of the compared evaluations, with the human specialist who came closest to this index obtained 75,5%. Conclusion It can be concluded that with the methodology used, the investigation met the objectives and confirmed the initial hypothesis. There are indications that the system can help in the Pharmacotherapy review process, being able to find prescription errors as well as to establish times for the use of medications according to the patient’s routine.

Integrating Information Visualization and Dimensionality Reduction: A pathway to Bridge the Gap between Natural and Artificial Intelligence

By importing some natural abilities from human thinking into the design of computerized decision support systems, a cross-cutting trend of intelligent systems has emerged, namely, the synergetic integration between natural and artificial intelligence. While natural intelligence provides creative, parallel, and holistic thinking, its artificial counterpart is logical, accurate, able to perform complex and extensive calculations, and tireless. In the light of such integration, two concepts are important: controllability and interpretability. The former is defined as the ability of computerized systems to receive feedback and follow users’ instructions, while the latter refers to human-machine communication. A suitable alternative to simultaneously involve these two concepts—and then bridging the gap between natural and artificial intelligence—is bringing together the fields of dimensionality reduction (DimRed) and information visualization (InfoVis).

Development and Implementation of a Computerized Decision Support Systems in the Interdisciplinary Treatment of Stage IV Pressure Injury in Patients with Spinal Cord Injury: A Real Life Two-Group Parallel Design

Background: Treatment of pressure injury (PI) stage III and IV in patients with spinal cord injury (SCI) requires complex interdisciplinary and inter-professional management described in comprehensive concepts. Although the implementation of these concepts in the clinical management is still difficult due to practical aspects as information and coordination challenges for example. The aim of this study was to develop, implement and test a computerized decision support system (CDSS) to increase concept adherence, improve inter-professional collaboration and optimize clinical outcome compared to usual care. Method: We implemented a CDSS picturing the Basel Decubitus Concept in an acute and rehabilitation clinic specialized for SCI as part of a quality improvement project in a real life two-group parallel design. We randomly allocated patients with SCI and PI stage III/IV for inpatient treatment to usual or CDSS supported care. We used an inclusive participatory development process, a qualitative focus group-based (30 participants) approach to capture the user perspective and prospective chart analyses to compare complication rates, length of stay and costs. Results: In both groups 15 patients were included showing no differences in SCI characteristics, comorbidities, and PI characteristics (localisation: ischium (19 PI, 63%), sacrum (10 PI, 33%), recurrent PI in 21 patients (70%)). Twenty-seven patients received surgical treatment (rotation flap in 12 patients (40%), posterior thigh flap in 15 patients (50%)). No statistically significant group differences were observed in the frequency of major (20% vs 13% between CDSS and control group) and minor (33% vs 27%) complications and length of stay (98 (±28) vs 81 (±23) days). The costs were similar. Although, health care professionals experienced the CDSS as helpful, high workload and difficulties in the information technology processes hindered its implementation.Conclusion: The introduction of a CDSS in the treatment of PI stage III/IV in patients with SCI was feasible, but technical and application problems limited its effectiveness. During the implementation and testing we learned that a clear definition of the whole treatment concept includes milestones, interventions and outcome definition. Technical requirements should include efficient reminder systems and clear visibility for all disciplines of the whole process. Trial registration: As a quality assurance study, this project holds a declaration of no objection by the Ethics Committee northwest/central Switzerland (EKNZ UBE-16/003) and received an ethical approval (EKNZ Req-2017-00860).

Effectiveness, safety and implementation results of the strategies aimed at the safe prescription of medications in university hospitals in adult patients. Systematic review

Introduction: A broad range of practices aimed at improving the effectives and safety of this process have been documented over the past few years. Objective: to establish the effectiveness, safety and results of the implementation of these strategies in adult patients in university hospitals. Methodology: A review of systematic reviews was conducted, in addition to a database search in the Cochrane Library of Systematic Reviews, Embase, Epistemonikos, LILACS and gray literature. Any strategy aimed at reducing prescription-associated risks was included as intervention. This review followed the protocol registered in the International Prospective Registry of Systematic Reviews (PROSPERO): CRD42020165143. Results: 7,637 studies were identified, upon deleting duplicate references. After excluding records based on titles and abstracts, 111 full texts were assessed for eligibility. Fifteen studies were included in the review. Several interventions grouped into 5 strategies addressed to the prescription process were identified; the use of computerized medical order entry systems (CPOE), whether integrated or not with computerized decision support systems (CDSS), was the most effective approach. Conclusions: The beneficial effects of the interventions intended to the prescription process in terms of efficacy were identified; however, safety and implementation results were not thoroughly assessed. The heterogeneity of the studies and the low quality of the reviews, preclude a meta-analysis.

Penerapan Metode Rank Order Centroid dan Additive Ratio Assessment Pada Aplikasi Rekomendasi Supplier

PT.Yanmarindo Perkasa is a company in the sale of diesel engines, generators, tooling tools and engine spare parts. Many suppliers want to distribute their goods through PT.Yanmarindo Perkasa, thus demanding the company to choose the right supplier, in order to ensure the smooth fulfillment of stock items. The process of selecting suppliers is still done manually with criteria limited to quantitative criteria, so that the process takes a long time and the results are not precise. The purpose of this study is to build a decision support system for supplier recommendations quickly and precisely in meeting the company's needs. The supplier selection process uses the Rank-Order Centroid (ROC) method in weighting the criteria and the Additive Ratio Assessment (ARAS) for ranking. ARAS value obtained is the K value that is ranked to get the best supplier by using a computerized decision support system. The application of these two methods can speed up the results of decisions, does not take a long time and the results obtained are also maximum.