Registered nurses’ use of computerised decision support in medication reviews

Abstract

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.

Clinical Decision Support and Implications for the Clinician Burnout Crisis

“…Although metrics of relevance such as sensitivity, specificity, and positive predictive value (PPV) were referenced several times 77 84 85 86 87 88 , only one study evaluated these metrics as pre-specified outcomes 49 . Tools for capturing clinician burnout, stress, or satisfaction after using a CDS tool were used in nine studies 26 44 78 80 82 89 90 91 92 . Psychometric measures of the user interface, such as mouse clicks, eye movement tracking, time spent on the page, errors using the tool, or direct observation were captured in seven studies 29 49 54 59 82 89 93 .…”

“…Tools for capturing clinician burnout, stress, or satisfaction after using a CDS tool were used in nine studies 26 44 78 80 82 89 90 91 92 . Psychometric measures of the user interface, such as mouse clicks, eye movement tracking, time spent on the page, errors using the tool, or direct observation were captured in seven studies 29 49 54 59 82 89 93 . Efficiency metrics of task completion time or clinic appointment time were obtained in seven studies 29 44 60 61 89 91 94 .…”

“…Psychometric measures of the user interface, such as mouse clicks, eye movement tracking, time spent on the page, errors using the tool, or direct observation were captured in seven studies 29 49 54 59 82 89 93 . Efficiency metrics of task completion time or clinic appointment time were obtained in seven studies 29 44 60 61 89 91 94 . How often a non-mandatory CDS tool was used, a proxy of whether clinicians found the tool useful and acceptable, was studied in five publications 27 53 56 93 95 .…”

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“…In studies involving care or nursing homes residents, the largest study population was 6161 residents [ 21 ], and the smallest study population was 52 residents in the study by Walker et al [ 24 ]. In studies involving health care professionals, the largest number of participants was 27 staff members in the study by Coulongeat et al [ 10 ], and the smallest number of participants was 14 registered nurses in the study by Johansson-Pajala et al [ 16 ].…”

Analyzing Nursing Students’ Relation to Electronic Health and Technology as Individuals and Students and in Their Future Career (the eNursEd Study): Protocol for a Longitudinal Study

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