Int J Med Inform - Barriers and facilitators to the use of computer-based intensive insulin therapy.

Tópicos

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Resumo

RPOSE: Computerized clinical decision support systems (CDSSs) for intensive insulin therapy (IIT) are increasingly common. However, recent studies question IIT's safety and mortality benefit. Researchers have identified factors influencing IIT performance, but little is known about how workflow affects computer-based IIT. We used ethnographic methods to evaluate IIT CDSS with respect to other clinical information systems and care processes.METHODS: We conducted direct observation of and unstructured interviews with nurses using IIT CDSS in the surgical and trauma intensive care units at an academic medical center. We observed 49h of intensive care unit workflow including 49 instances of nurses using IIT CDSS embedded in a provider order entry system. Observations focused on the interaction of people, process, and technology. By analyzing qualitative field note data through an inductive approach, we identified barriers and facilitators to IIT CDSS use.RESULTS: Barriers included (1) workload tradeoffs between computer system use and direct patient care, especially related to electronic nursing documentation, (2) lack of IIT CDSS protocol reminders, (3) inaccurate user interface design assumptions, and (4) potential for error in operating medical devices. Facilitators included (1) nurse trust in IIT CDSS combined with clinical judgment, (2) nurse resilience, and (3) paper serving as an intermediary between patient bedside and IIT CDSS.CONCLUSION: This analysis revealed sociotechnical interactions affecting IIT CDSS that previous studies have not addressed. These issues may influence protocol performance at other institutions. Findings have implications for IIT CDSS user interface design and alerts, and may contribute to nascent general CDSS theory.

Resumo Limpo

rpose computer clinic decis support system cdsss intens insulin therapi iit increas common howev recent studi question iit safeti mortal benefit research identifi factor influenc iit perform littl known workflow affect computerbas iit use ethnograph method evalu iit cdss respect clinic inform system care processesmethod conduct direct observ unstructur interview nurs use iit cdss surgic trauma intens care unit academ medic center observ h intens care unit workflow includ instanc nurs use iit cdss embed provid order entri system observ focus interact peopl process technolog analyz qualit field note data induct approach identifi barrier facilit iit cdss useresult barrier includ workload tradeoff comput system use direct patient care especi relat electron nurs document lack iit cdss protocol remind inaccur user interfac design assumpt potenti error oper medic devic facilit includ nurs trust iit cdss combin clinic judgment nurs resili paper serv intermediari patient bedsid iit cdssconclus analysi reveal sociotechn interact affect iit cdss previous studi address issu may influenc protocol perform institut find implic iit cdss user interfac design alert may contribut nascent general cdss theori

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