Summary
Objectives
To understand requests for nursing Clinical Decision Support (CDS) interventions at
a large integrated health system undergoing vendor-based EHR implementation. In addition,
to establish a process to guide both short-term implementation and long-term strategic
goals to meet nursing CDS needs.
Materials and Methods
We conducted an environmental scan to understand current state of nursing CDS over
three months. The environmental scan consisted of a literature review and an analysis
of CDS requests received from across our health system. We identified existing high
priority CDS and paper-based tools used in nursing practice at our health system that
guide decision-making.
Results
A total of 46 nursing CDS requests were received. Fifty-six percent (n=26) were specific
to a clinical specialty; 22 percent (n=10) were focused on facilitating clinical consults
in the inpatient setting. “Risk Assessments/Risk Reduction/Promotion of Healthy Habits”
(n=23) was the most requested High Priority Category received for nursing CDS. A continuum
of types of nursing CDS needs emerged using the Data-Information-Knowledge-Wisdom
Conceptual Framework: 1) facilitating data capture, 2) meeting information needs,
3) guiding knowledge-based decision making, and 4) exposing analytics for wisdom-based
clinical interpretation by the nurse.
Conclusion
Identifying and prioritizing paper-based tools that can be modified into electronic
CDS is a challenge. CDS strategy is an evolving process that relies on close collaboration
and engagement with clinical sites for short-term implementation and should be incorporated
into a long-term strategic plan that can be optimized and achieved overtime. The Data-Information-Knowledge-Wisdom
Conceptual Framework in conjunction with the High Priority Categories established
may be a useful tool to guide a strategic approach for meeting short-term nursing
CDS needs and aligning with the organizational strategic plan.
Keywords
Electronic health records - evidence-based nursing - hospital information systems
- clinical decision support - nursing informatics
