Qualitative Evaluation of the Barriers and Facilitators Influencing the Use of an Electronic Basal Bolus Insulin Therapy Protocol to Improve the Care of Adult Inpatients With Diabetes

Helmle, Karmon; Edwards, Alun; Kushniruk, André; Borycki, Elizabeth M.

doi:10.1016/j.jcjd.2017.10.059

Cited by 8 publications

(18 citation statements)

References 20 publications

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“…The most common evaluation was via interviews (n=29) , followed by surveys or questionnaires (n=16) [27,29,50,53,[55][56][57][58][59][60][61][62][63][64][65][66]. Other qualitative feedback responses were obtained by focus groups or workshops (n=5) [43,57,61,67,68]. The alert firing rate (n=12) [43,55,62,[69][70][71][72][73][74][75][76][77] and alert acceptance rate (n=15) [27,29,43,58,61,62,69,74,[78][79][80][81][82][83][84] were also common metrics used to understand alarm fatigue and acceptability.…”

Section: How and How Much -Methods And Metricsmentioning

confidence: 99%

“…Usability of the tool itself is one example. Encouragingly, several studies emphasized developing tools that incorporated user-centered design, such as clean, concise, and intuitive interfaces [26,30,50,67]. However, several studies cited the need for an improved CDS user interface, such as limiting mouse-clicks or not having the pop-up window block access to the chart [35,93,99].…”

Section: Make It Easy -Workflow Efficiency and Integrationmentioning

confidence: 99%

“…An investigation into why clinician adoption of a CDS tool was only 4-14% identified lack of buy-in as one of the factors deterring use [93]. Some studies noted concerns that CDS threatened clinician autonomy [67] or that CDS use would be monitored for punitive reasons [33]. For example, users were offended by the CDS prompt to use basal-bolus insulin when only sliding scale insulin had been ordered [67], demonstrating that even when CDS is supporting the evidence-based regimen the prompt needs to be palatable to clinicians.…”

Section: I'm a Believer -Clinician Buy-inmentioning

confidence: 99%

“…Some studies noted concerns that CDS threatened clinician autonomy [67] or that CDS use would be monitored for punitive reasons [33]. For example, users were offended by the CDS prompt to use basal-bolus insulin when only sliding scale insulin had been ordered [67], demonstrating that even when CDS is supporting the evidence-based regimen the prompt needs to be palatable to clinicians. Accordingly, another study proposed increasing buy-in by framing CDS positively instead of negatively and making users feel recognized for their efforts [28].…”

Section: I'm a Believer -Clinician Buy-inmentioning

confidence: 99%

“…Alerts tailored by role could also be used in cases where the ownership of an alert would otherwise be ambiguous, such as results of a genomic test [37]. Separate from role-tailoring, CDS that "nudges" [26] could be used to combat concerns about loss of autonomy [67]. Relevance could also be improved by tiering of alerts [20,22].…”

Section: Fix It -Improving Cdsmentioning

confidence: 99%

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Clinical Decision Support and Implications for the Clinician Burnout Crisis

Janković

Chen

2020

Yearb Med Inform

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Objectives: This survey aimed to review aspects of clinical decision support (CDS) that contribute to burnout and identify key themes for improving the acceptability of CDS to clinicians, with the goal of decreasing said burnout. Methods: We performed a survey of relevant articles from 2018-2019 addressing CDS and aspects of clinician burnout from PubMed and Web of Science™. Themes were manually extracted from publications that met inclusion criteria. Results: Eighty-nine articles met inclusion criteria, including 12 review articles. Review articles were either prescriptive, describing how CDS should work, or analytic, describing how current CDS tools are deployed. The non-review articles largely demonstrated poor relevance and acceptability of current tools, and few studies showed benefits in terms of efficiency or patient outcomes from implemented CDS. Encouragingly, multiple studies highlighted steps that succeeded in improving both acceptability and relevance of CDS. Conclusions: CDS can contribute to clinician frustration and burnout. Using the techniques of improving relevance, soliciting feedback, customization, measurement of outcomes and metrics, and iteration, the effects of CDS on burnout can be ameliorated.

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Section: How and How Much -Methods And Metricsmentioning

confidence: 99%

Section: Make It Easy -Workflow Efficiency and Integrationmentioning

confidence: 99%

Section: I'm a Believer -Clinician Buy-inmentioning

confidence: 99%

Section: I'm a Believer -Clinician Buy-inmentioning

confidence: 99%

Section: Fix It -Improving Cdsmentioning

confidence: 99%

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Clinical Decision Support and Implications for the Clinician Burnout Crisis

Janković

Chen

2020

Yearb Med Inform

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Qualitative evaluation in nursing interventions—A review of the literature

et al. 2020

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Aim To identify and synthesize qualitative evaluation methods used in nursing interventions. Design A systematic qualitative review with a content analysis. Four databases were used: MEDLINE, PsycINFO, Embase and CINAHL using pre‐defined terms. The included papers were published from 2014–2018. Methods We followed the guidelines of Dixon‐Woods et al., Sandelowski and Barroso, the Critical Appraisal Skills Programme qualitative checklist and The Confidence in the Evidence from Reviews of Qualitative Research Approach. Results Of 103 papers, 15 were eligible for inclusion. The main theme Challenging complexity by evaluating qualitatively described processes and characteristics of qualitative evaluation. Two analytic themes emerged: Evaluating the implementation process and Evaluating improvements brought about by the programme. Conclusion Different qualitative evaluation methods in nursing are a way of documenting knowledge that is difficult to illuminate in natural settings and make an important contribution when determining the pros and cons of an intervention.

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