Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study

Abstract

Background Stage III and IV pressure injuries (PIs) in patients with spinal cord injury (SCI) require complex interdisciplinary and interprofessional treatment approaches that are difficult to implement. Practical aspects, such as information exchange and coordination, remain challenging. We investigated whether a computerized decision support system (CDSS) could increase treatment adherence and improve clinical outcomes and interprofessional collaboration. Method In this feasibility study, a core team developed the initial treatment process and adapted it based on several discussions with clinical experts and information technologists. The CDSS followed the Basel Decubitus Approach and was used in a clinic specializing in SCI. Thirty patients with SCI admitted for stage III/IV PI between July 2016 and May 2017 were randomly allocated to standard or CDSS-supported care. Between-group differences in treatment adherence, complication rates, length of stay, and costs were analyzed using descriptive statistics. The use of the CDSS and potential barriers and facilitators were evaluated through interprofessional focus groups, transcribed verbatim, and thematically analyzed (30 participants). Results No differences in SCI characteristics, comorbidities, or PI characteristics (localization: ischium [number (n) = 19 PI, 63%], sacrum [n = 10 PI, 33%], recurrent PI [n = 21, 70%]) were found between the two groups. Furthermore, no statistically significant differences were observed in treatment adherence, 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). Healthcare professionals found the CDSS to be helpful for visualizing the treatment process. However, the high workload and difficulties in the information technology processes, such as missing reminders, slow computer performance and data processing, and poor accessibility, hindered the effective implementation of the CDSS. Conclusion The implementation of the CDSS to support the treatment of stage III/IV PI in patients with SCI was feasible and included definitions of milestones, interventions, and outcomes. However, to assess the impact of the CDSS, a longer observation period is required. Further, the technical difficulties must be addressed, and solid integration of the CDSS into the clinical information system is necessary. Trial Registration This quality improvement project received a declaration of no objection from the Ethics Committee of Northwest and Central Switzerland (EKNZ UBE-16/003), and ethical approval was received for the focus groups (EKNZ Req-2017-00860).

Gestão e monitoramento dos registros de lesões de pele com apoio das tecnologias de informação e comunicação: Uma revisão integrativa

“…(ferimentos e lesões OR feridas) AND (tecnologia da informação OR software) AND (registro médico OR prontuário) AND ( fulltext:("1" OR "1" OR "1" OR "1" OR "1" OR "1" OR "1" OR "1" OR "1" OR "1") AND db:("LILACS")) :("1" OR "1" OR "1" OR "1" OR "1" OR "1" OR "1" OR "1") AND db:("BDENF")) AND (year_cluster:[2013TO 2023)…”

“…Pacientes com feridas crônicas frequentemente sofrem perda de produtividade, sofrimento psicológico e redução da qualidade de vida. Inúmeros estudos apontam que o tratamento dessas feridas é complexo, multifatorial e dispendioso, ademais aumenta tempo de internação, maior risco de morbimortalidade, e impacta nos indicadores de qualidade das instituições hospitalares (Pokorná et al, 2017;Rodrigues et al 2013;Sen et al, 2009;Cho et al, 2020;Bitner et al, 2019;Scheel-sailer et al, 2023) Segundo recomendação da Joint Commission International (JCI), dentre os elementos de desempenho visando à prevenção e ao cuidado associados à lesão por pressão estão: avaliação do paciente na sua admissão para identificação de risco, avaliação sistemática de risco para lesão por pressão, reavaliação em intervalos definidos, implementação de medidas preventivas baseadas no risco e educação da equipe (JCI, 2020). No entanto, apenas 04 das publicações estudadas referem possuir ferramentas de alerta para análise e gerenciamento de risco, como pode ser visto no Quadro 4.…”