Developing Mobile Clinical Decision Support for Nursing Home Staff Assessment of Urinary Tract Infection using Goal-Directed Design

Jones, Wallace; Drake, Cynthia; Mack, David; Reeder, Blaine; Trautner, Barbara W.; Wald, Heidi L.

doi:10.4338/aci-2016-12-ra-0209

Cited by 20 publications

(15 citation statements)

References 42 publications

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“…Given the differences we found when RNs had infection control training and were put under a forced-deliberation condition, our work highlights the potential benefit of clinical support systems that improve RNs' knowledge about infections such as UTIs and changes the process of decision-making. 61 Interventions that help nurses take the time to deliberate over the information they receive and empower them to use the time to respond to the signs and symptoms of UTIs with appropriate symptom management strategies could potentially relieve NH resident suffering. These efforts could impact the overprescribing of antimicrobials and enhance antimicrobial stewardship for NH residents with suspected UTIs.…”

Section: Discussionmentioning

confidence: 99%

Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse

Beeber

Kistler

Zimmerman

et al. 2021

Journal of the American Medical Directors Association

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Objectives:To determine what information is most important to registered nurses' (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents. Design: Web-based discrete choice experiment with 19 clinical scenarios. Setting and Participants: Online survey with a convenience sample of RNs (N ¼ 881) recruited from a health care research panel. Methods: Clinical scenarios used information from 10 categories of resident characteristics: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical examination, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions (self-paced, n ¼ 437 and forced deliberation, n ¼ 444). The degree to which evidence-and noneevidence-based information was important to decision-making was estimated using unconditional multinomial logistic regression. Results: For all nurses (22.8%) and the self-paced group (24.1%), lower urinary tract status had the highest importance scores for the decision to call a clinician about a suspected UTI. For the forced-deliberation group, body temperature was most important (23.7%), and lower urinary tract status was less important (21%, P ¼.001). The information associated with the highest odds of an RN calling about a suspected UTI was painful or difficult urination [odds ratio (OR) 4.85, 95% confidence interval (CI) 4.16e5.65], obvious blood in urine (OR 4.66, 95% CI 3.99e5.44), and temperature at 101.5 (OR 3.80, 95% CI 3.28e4.42). For the self-paced group, painful or difficult urination (OR 5.65, 95% CI 4.53e7.04) had the highest odds, whereas obvious blood in urine (OR 4.39, 95% CI 3.53e5.47) had highest odds for the forced-deliberation group. Conclusions and Implications: This study highlighted the importance of specific resident characteristics in nurse decision-making about suspected UTIs. Future antimicrobial stewardship efforts should aim to not only improve the previously studied overprescribing practices of clinicians, but to improve nurses' assessment of signs and symptoms of potential infections and how they weigh resident information.

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Section: Discussionmentioning

confidence: 99%

Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse

Beeber

Kistler

Zimmerman

et al. 2021

Journal of the American Medical Directors Association

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“…Fundamental to this work will be the need to continually monitor the CDS to assure improved usability after successful migration into a more contemporary EHR, ongoing clinical applicability, and continued provider acceptance, 34,35 while maintaining the user-centered interdisciplinary design approach that can benefit the goals of both targeted providers and the health care systems. 30,36 Ultimately, if successful, this approach will be expanded into CDS imaging guidance for the diagnosis and nonsurgical treatments of other musculoskeletal disorders.…”

Section: Discussionmentioning

confidence: 99%

Joint Design with Providers of Clinical Decision Support for Value-Based Advanced Shoulder Imaging

et al. 2020

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Background Provider orders for inappropriate advanced imaging, while rarely altering patient management, contribute enough to the strain on available health care resources, and therefore the United States Congress established the Appropriate Use Criteria Program. Objectives To examine whether co-designing clinical decision support (CDS) with referring providers will reduce barriers to adoption and facilitate more appropriate shoulder ultrasound (US) over magnetic resonance imaging (MRI) in diagnosing Veteran shoulder pain, given similar efficacies and only 5% MRI follow-up rate after shoulder US. Methods We used a theory-driven, convergent parallel mixed-methods approach to prospectively (1) determine medical providers' reasons for selecting MRI over US in diagnosing shoulder pain and identify barriers to ordering US, (2) co-design CDS, informed by provider interviews, to prompt appropriate US use, and (3) assess CDS impact on shoulder imaging use. CDS effectiveness in guiding appropriate shoulder imaging was evaluated through monthly monitoring of ordering data at our quaternary care Veterans Hospital. Key outcome measures were appropriate MRI/US use rates and transition to ordering US by both musculoskeletal specialist and generalist providers. We assessed differences in ordering using a generalized estimating equations logistic regression model. We compared continuous measures using mixed effects analysis of variance with log-transformed data. Results During December 2016 to March 2018, 569 (395 MRI, 174 US) shoulder advanced imaging examinations were ordered by 111 providers. CDS “co-designed” in collaboration with providers increased US from 17% (58/335) to 50% (116/234) of all orders (p < 0.001), with concomitant decrease in MRI. Ordering appropriateness more than doubled from 31% (105/335) to 67% (157/234) following CDS (p < 0.001). Interviews confirmed that generalist providers want help in appropriately ordering advanced imaging. Conclusion Partnering with medical providers to co-design CDS reduced barriers and prompted appropriate transition to US from MRI for shoulder pain diagnosis, promoting evidence-based practice. This approach can inform the development and implementation of other forms of CDS.

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“…den Rettungsdienst und vernachlässigen die Perspektivev on Pflegefachpersonen. Jones et al (2017) haben den Prototyp eines mobilenE ntscheidungshilfe-Systems (clinical decision support system, CDSS) für Pflegepersonen in Einrichtungen der Langzeitpflege entwickelt. Das mobileC DSS wurde unter Einbeziehungv on Pflegepersonen entwickeltund dient der Unterstützung bei der Erkennung und Behandlung vonHarnwegsinfektionen.Ziel ist es, die Gabe von Antibiotika bei Harnwegsinfektionen durch eine verbessertep flegerische Versorgung zu reduzieren.…”

Section: A) Handlungsempfehlungenunclassified

“…Das mobileC DSS wurde unter Einbeziehungv on Pflegepersonen entwickeltund dient der Unterstützung bei der Erkennung und Behandlung vonHarnwegsinfektionen.Ziel ist es, die Gabe von Antibiotika bei Harnwegsinfektionen durch eine verbessertep flegerische Versorgung zu reduzieren. Das CDSS lässt sich auf dem Smartphone ausführen und wurde vond en Pflegefachpersonen überwiegend positiv evaluiert ( Jones et al 2017). Allerdingswird der Bewohner:innenwille in diesem CDSS nicht mit einbezogen.…”

Section: A) Handlungsempfehlungenunclassified

App schlägt Papier? Einstellungen von Pflegefachpersonen zu app-basierten Handlungsanweisungen für Notfallsituationen in der stationären Langzeitpflege

Rubeis,

Hatziavramidis,

Primc

2022

Digitalisierung Der Pflege

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Einen ersten Ansatz, diese Forschungslücke zu schließen,s tellt das Projekt NOVELLE(Sektorenübergreifendes & integriertes Notfall-und Verfügungsmanagement für die letzte Lebensphase in der stationären Langzeitpflege) dar. Ziel des Projekts ist die Entwicklung vonH andlungsempfehlungen für Pflegefachpersonen, die deren Handlungssicherheit in Notfallsituationen stärken und dabei die Einbeziehung des Willens vonB ewohner:innens ichern sollen. Im Rahmen vonN OVELLEw urde u. a. ermittelt, ob die zu entwickelnden Hand-lungsempfehlungeninPapierform oder in digitaler Form, d. h. als App für mobile Endgeräte, vorliegen sollen. Dazu wurde die Perspektiveder Pflegefachpersonen erhoben. In diesem Beitrag werden die Resultate dieser Erhebungmit Fokus auf den Einstellungen der Pflegefachpersonen gegenüber der Implementierung von Handlungsanweisungen in Form vonApps dargestelltund diskutiert. Dazu wird im Folgenden zunächst der Hintergrund des Forschungsprojekts beschrieben, Open-Access-Publikation im Sinne der CC-Lizenz BY 4.0

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Developing Mobile Clinical Decision Support for Nursing Home Staff Assessment of Urinary Tract Infection using Goal-Directed Design

Cited by 20 publications

References 42 publications

Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse

Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse

Joint Design with Providers of Clinical Decision Support for Value-Based Advanced Shoulder Imaging

App schlägt Papier? Einstellungen von Pflegefachpersonen zu app-basierten Handlungsanweisungen für Notfallsituationen in der stationären Langzeitpflege

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