J Am Med Inform Assoc - The influence of computerized decision support on prescribing during ward-rounds: are the decision-makers targeted?

Tópicos

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Resumo

JECTIVE: To assess whether a low level of decision support within a hospital computerized provider order entry system has an observable influence on the medication ordering process on ward-rounds and to assess prescribers' views of the decision support features.METHODS: 14 specialty teams (46 doctors) were shadowed by the investigator while on their ward-rounds and 16 prescribers from these teams were interviewed.RESULTS: Senior doctors were highly influential in prescribing decisions during ward-rounds but rarely used the computerized provider order entry system. Junior doctors entered the majority of medication orders into the system, nearly always ignored computerized alerts and never raised their occurrence with other doctors on ward-rounds. Interviews with doctors revealed that some decision support features were valued but most were not perceived to be useful.DISCUSSION AND CONCLUSION: The computerized alerts failed to target the doctors who were making the prescribing decisions on ward-rounds. Senior doctors were the decision makers, yet the junior doctors who used the system received the alerts. As a result, the alert information was generally ignored and not incorporated into the decision-making processes on ward-rounds. The greatest value of decision support in this setting may be in non-ward-round situations where senior doctors are less influential. Identifying how prescribing systems are used during different clinical activities can guide the design of decision support that effectively supports users in different situations. If confirmed, the findings reported here present a specific focus and user group for designers of medication decision support.

Resumo Limpo

jectiv assess whether low level decis support within hospit computer provid order entri system observ influenc medic order process wardround assess prescrib view decis support featuresmethod specialti team doctor shadow investig wardround prescrib team interviewedresult senior doctor high influenti prescrib decis wardround rare use computer provid order entri system junior doctor enter major medic order system near alway ignor computer alert never rais occurr doctor wardround interview doctor reveal decis support featur valu perceiv usefuldiscuss conclus computer alert fail target doctor make prescrib decis wardround senior doctor decis maker yet junior doctor use system receiv alert result alert inform general ignor incorpor decisionmak process wardround greatest valu decis support set may nonwardround situat senior doctor less influenti identifi prescrib system use differ clinic activ can guid design decis support effect support user differ situat confirm find report present specif focus user group design medic decis support

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