Paper
Friday, July 13, 2007
Evaluation of an Electronic Point of Care Decision-Support System
D. M. Doran, RN, PhD1, John Mylopoulos, PhD2, André Kushniruk, PhD3, Lynn Nagle, RN, PhD1, Souraya Sidani, PhD1, Brenda Laurie-Shaw, RN, MN4, Ann Tourangeau, RN, PhD1, Nancy Lefebre, RN, BScN, MScN5, Cheryl Reid-Haughian, RN, MHScN6, and Tammie DiPietro1. (1) Faculty of Nursing, University of Toronto, Toronto, ON, Canada, (2) Computer Science, University of Toronto, Toronto, ON, Canada, (3) School of Health Information Science, University of Victoria, Victoria, BC, Canada, (4) Nursing Informatics, University Health Network, Toronto, ON, Canada, (5) Saint Elizabeth Health Care, Markham, ON, Canada, (6) Professional Practice, ParaMed Home Health Care, Ottawa, ON, Canada
| Learning Objective #1: recognize opportunities for improving evidence-based practice through electronic resources at the point-of-care |
| Learning Objective #2: understand nurses’ perceptions of the utility of electronic resources for point-of-care decision making |
It continues to be a challenge to ensure nurses have access to high quality evidence at the point of care. The study evaluated the use of an electronic decision-support system for enhancing nurses’ evidence-based decision-making.The Outcomes-Focused Knowledge Translation framework (Doran & Sidani) and Promoting Action on Research Implementation in Health Services framework (Kitson et al., 1998, Rycroft-Malone et al., 2002) guided the intervention design. This presentation focuses on three factors: 1) patient outcomes measurement, 2) real-time feedback about outcomes achievement and 3) embedded best-practice guidelines. Fifty-two hospital and home care nurses used handheld computers (Personal Digital Assistants or PDAs) to document 283 patient assessments using the decision-support system. They also had access to an electronic drug handbook.
A quasi-experimental design was used to evaluate the usability and effectiveness of the electronic system for improving nurses’ use of patient outcomes data and best practice evidence to inform clinical decision-making. Following participation in a small group workshop, nurses used PDAs to document health outcome assessments. Best practice guidelines were presented if triggered by patient-specific data. At the end of the intervention period, nurse participants completed a usability questionnaire and a qualitative interview. The outcomes for patients cared for by study participants were compared with outcomes on control units where research staff completed the assessments and nurses did not have access to the electronic resources. The results of the study indicate that 1) outcomes data can be reliably documented electronically using handheld devices, 2) real-time feedback of graphical data is quickly understood; 3) nurses valued having access to electronic resources; but 4) there was no significant difference in patient outcomes between experimental and control units. A follow-up study is planned to investigate the effectiveness of a structured communication tool to guide team review and care planning in relation to patient outcomes data.