迈向有意义的护理计划临床决策支持：一项模拟试点研究的可行性与效果
Toward Meaningful Care Plan Clinical Decision Support: Feasibility and Effects of a Simulated Pilot Study.
作者信息
Keenan Gail M, Lopez Karen Dunn, Yao Yingwei, Sousa Vanessa E C, Stifter Janet, Febretti Alessandro, Johnson Andrew, Wilkie Diana J
机构信息
Gail M. Keenan, PhD, RN, FAAN, is Professor and Annabel Davis Jenks Endowed Chair for Teaching and Research in Clinical Nursing Excellence, Department of Family, Community and Health Systems Science, College of Nursing, University of Florida, Gainesville. Karen Dunn Lopez, PhD, RN, is Assistant Professor, Department of Health Systems Science, College of Nursing, University of Illinois at Chicago. Yingwei Yao, PhD, is Research Associate Professor, Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, and Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago. Vanessa E. C. Sousa, PhD, RN, is Postdoctoral Fellow; and Janet Stifter, PhD, RN, CPHQ, is the Director of Center for Care Innovation and Transformation, the American Organization of Nurse Executives (AONE), Chicago, Illinois. Alessandro Febretti, MS, is Predoctoral Student; and Andrew Johnson, PhD, is Associate Professor, Electronic Visualization Laboratory, Department of Computer Science, College of Engineering, University of Illinois at Chicago. Diana J. Wilkie, PhD, RN, FAAN, is Professor, Prairieview Trust-Earl and Margo Powers Endowed Professor, and Director, Academic Center of Excellence in Palliative Care Research and Education, Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, and Professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago.
出版信息
Nurs Res. 2017 Sep/Oct;66(5):388-398. doi: 10.1097/NNR.0000000000000234.
BACKGROUND
Clinical decision support (CDS) tools-with easily understood and actionable information, at the point of care-are needed to help registered nurses (RNs) make evidence-based decisions. Not clear are the optimal formats of CDS tools. Thorough, preclinical testing is desirable to avoid costly errors associated with premature implementation in electronic health records.
OBJECTIVE
The aims of this study were to determine feasibility of the protocol designed to compare multiple CDS formats and evaluate effects of numeracy and graph literacy on RN adoption of best practices and care planning time in a simulated environment.
METHODS
In this pilot study, 60 RNs were randomly assigned to one of four CDS conditions (control, text, text + graph, and text + table) and asked to adjust the plan of care for two patient scenarios over three shifts. Fourteen best practices were identified for the two patients and sent as suggestions with evidence to the three CDS groups. Best practice adoption rates, care planning time, and their relationship to the RN's numeracy and graph literacy scores were assessed.
RESULTS
CDS groups had a higher adoption rate of best practices (p < .001) across all shifts and decreased care planning time in shifts 2 (p = .01) and 3 (p = .02) compared with the control group. Higher numeracy and graph literacy were associated with shorter care planning times under text + table (p = .05) and text + graph (p = .01) conditions. No significant differences were found between the three CDS groups on adoption rate and care planning time.
DISCUSSION
This pilot study shows the feasibility of our protocol. Findings show preliminary evidence that CDS improves the efficiency and effectiveness of care planning decisions and that the optimal format may depend on individual RN characteristics. We recommend a study with sufficient power to compare different CDS formats and assess the impact of potential covariates on adoption rates and care planning time.
背景
临床决策支持（CDS）工具需要在护理点提供易于理解且可操作的信息，以帮助注册护士（RN）做出基于证据的决策。目前尚不清楚CDS工具的最佳形式。进行全面的临床前测试有助于避免与过早应用于电子健康记录相关的代价高昂的错误。
目的
本研究旨在确定旨在比较多种CDS形式的方案的可行性，并评估在模拟环境中，数字运算能力和图表素养对RN采用最佳实践及护理计划时间的影响。
方法
在这项试点研究中，60名RN被随机分配到四种CDS条件之一（对照组、文本组、文本+图表组和文本+表格组），并被要求在三个班次中针对两个患者场景调整护理计划。为这两名患者确定了14项最佳实践，并作为带有证据的建议发送给三个CDS组。评估最佳实践采用率、护理计划时间，以及它们与RN的数字运算能力和图表素养分数的关系。
结果
与对照组相比，CDS组在所有班次中的最佳实践采用率更高（p < 0.001），并且在第2个班次（p = 0.01）和第3个班次（p = 0.02）中护理计划时间减少。在文本+表格（p = 0.05）和文本+图表（p = 0.01）条件下，更高的数字运算能力和图表素养与更短的护理计划时间相关。三个CDS组在采用率和护理计划时间方面未发现显著差异。
讨论
这项试点研究表明了我们方案的可行性。研究结果初步证明，CDS可提高护理计划决策的效率和效果，最佳形式可能取决于RN的个体特征。我们建议进行一项有足够效力的研究，以比较不同的CDS形式，并评估潜在协变量对采用率和护理计划时间的影响。
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