Enhancing the Utilization of Best Practice Guidelines to Improve Patient Care through Outcomes Data Collection and Real-Time Feedback

D. M. Doran, RN, PhD¹, John Mylopoulos, PhD², André Kushniruk, PhD³, Lynn M. Nagle, PhD, RN⁴, Sharon E. Straus, MD⁵, Souraya Sidani, RN, PhD¹, John P. Hirdes, PhD⁶, Brenda Laurie-Shaw, RN, MN⁷, Ann Tourangeau, RN, PhD¹, Edith M. Hillan, PhD, RN⁸, Nancy Lefebre, RN, BScN, MScN⁹, and Cheryl Reid-Haughian, RN, MHScN¹⁰. (1) Faculty of Nursing, University of Toronto, Toronto, ON, Canada, (2) Dept. of Computer Science, University of Toronto, Toronto, ON, Canada, (3) School of Health Information Science, University of Victoria, Victoria, BC, Canada, (4) Technology & Knowledge Management, Mount Sinai Hospital, Toronto, ON, Canada, (5) Dept of Medicine, University Health Network, Toronto, ON, Canada, (6) Dept. of Health Studies and Gerontology, University of Waterloo, Waterloo, ON, Canada, (7) Nursing Informatics, University Health Network, Toronto, ON, Canada, (8) Office of the Vice President & Provost, University of Toronto, Toronto, ON, Canada, (9) Saint Elizabeth Health Care, Markham, ON, Canada, (10) Professional Practice, ParaMed Home Health Care, Ottawa, ON, Canada

Background

With the current explosion of health related knowledge, it is a challenge for nurses to regularly access the information that is most current. Mobile computing technology, such as personal digital assistants (PDAs), addresses that need by providing the opportunity to access relevant information immediately at the time of nurse/patient contact. Purpose

The purpose of this study was to evaluate an intervention that provides nurses with real-time feedback about patient outcome achievement, and that links evidence-based practice to outcomes feedback at the POC. Methods

A prototype software system was developed that enables nurses to use PDAs to collect patient outcomes data and access relevant best-practice guidelines to inform clinical decision-making. A controlled laboratory setting was used to 1) evaluate the usability of the prototype system, and 2) to assess the impact of providing nurses with real-time feedback about patient outcome achievement and best practice guidelines on clinical decision making. Nurses were asked to assess a standardized patient, and to document their assessment using either a PDA with immediate links to patient-specific guidelines, or to use a laptop computer with no direct links to best-practice information. The sample consisted of 40 nurses. Data collection involved video and audio recording, and questionnaire. Results

Results of usability testing indicated that nurses believe the prototype system provides adequate power to enter information, to correct data entry misstates, it is easy to enter information, and it is easy to use the PDA to look up electronically-accessible information. The size of the PDA screen was the lowest ranked item, on a scale of 1 to 9. Conclusions

The prototype system has the potential to improve ease of health information documentation and health information utilization. It is also anticipated that real-time outcomes feedback will motivate nurses to seek best practice guidelines and other evidence-based resources.

Learning Objective #1: develop knowledge about a theoretical framework for improving nurses' utilization of best practice guidelines to promote quality patient care.
Learning Objective #2: develop knowledge about the usability of point-of-care technology to increase nurses' utilization of evidence for clinical decision making.