Johansson-Pajala Rose-Marie, Martin Lene, Jorsäter Blomgren Kerstin
Mälardalen University , Västerås, Sweden.
Int J Health Care Qual Assur. 2018 Jul 9;31(6):531-544. doi: 10.1108/IJHCQA-01-2017-0009.
Purpose The purpose of this paper is to explore the implications of registered nurses' (RNs) use of a computerized decision support system (CDSS) in medication reviews. Design/methodology/approach The paper employs a quasi-experimental, one-group pre-test/post-test design with three- and six-month follow-ups subsequent to the introduction of a CDSS. In total, 11 RNs initiated and prepared a total of 54 medication reviews. The outcome measures were the number of drug-related problems (DRPs) as reported by the CDSS and the RNs, respectively, the RNs' views on the CDSS, and changes in the quality of drug treatment. Findings The CDSS significantly indicated more DRPs than the RNs did, such as potential adverse drug reactions (ADRs). The RNs detected additional problems, outside the scope of the CDSS, such as lack of adherence. They considered the CDSS beneficial and wanted to continue using it. Only minor changes were found in the quality of drug treatments, with no significant changes in the drug-specific quality indicators (e.g. inappropriate drugs). However, the use of renally excreted drugs in reduced renal function decreased. Practical implications The RNs' use of a CDSS in medication reviews is of value in detecting potential ADRs and interactions. Yet, in order to have an impact on outcomes in the quality of drug treatment, further measures are needed. These may involve development of inter-professional collaboration, such as established procedures for the implementation of medication reviews, including the use of CDSS. Originality/value This is, to the best of the authors' knowledge, the first study to explore the implications of medication reviews, initiated and prepared by RNs who use a CDSS. The paper adds further insight into the RNs' role in relation to quality of drug treatments.
目的 本文旨在探讨注册护士（RN）在药物审查中使用计算机化决策支持系统（CDSS）的影响。
设计/方法/途径 本文采用准实验性的单组前测/后测设计，在引入CDSS后进行为期三个月和六个月的随访。共有11名注册护士发起并完成了总共54次药物审查。结果指标分别为CDSS和注册护士报告的药物相关问题（DRP）数量、注册护士对CDSS的看法以及药物治疗质量的变化。
发现 CDSS显著指出的DRP比注册护士更多，如潜在的药物不良反应（ADR）。注册护士发现了CDSS范围之外的其他问题，如依从性不足。他们认为CDSS有益并希望继续使用。在药物治疗质量方面仅发现了微小变化，药物特异性质量指标（如不适当药物）没有显著变化。然而，肾功能减退患者中经肾脏排泄药物的使用减少。
实际意义 注册护士在药物审查中使用CDSS对于检测潜在的ADR和相互作用具有价值。然而，为了对药物治疗质量的结果产生影响，还需要进一步的措施。这些措施可能包括发展跨专业协作，如建立实施药物审查的程序，包括使用CDSS。
原创性/价值 据作者所知，这是第一项探讨由使用CDSS的注册护士发起并完成的药物审查影响的研究。本文进一步深入了解了注册护士在药物治疗质量方面的作用。
