Module Five

1. How did the readings influence your perception of your own clinical decision-making?

Clinical decision support systems are a tool designed to help improve accuracy with patient diagnoses (Courtney, Alexander and Demiris, 2008). Clinical decision support systems exist in four different ways in terms of providing patient care; systems use alerts to respond to clinical data, respond to decisions to alter care by critiquing decisions, suggest interventions at the request of care providers and conduct retrospective quality assurance reviews. Clinical decision support systems exist for diagnosing chest pain, ventilator management and HIV treatment and guidelines (Courtney, Alexander and Demiris, 2008).

The readings helped me to realize the widespread use of clinical decision support systems used in my own clinical decision making. The readings allowed me to appreciate the systems that were in place to help in patient care activities. Before the readings, I never put two and two together that there was such an abundance of clinical decision support systems in use at my work place.

Starting in triage, we have a sepsis alert system that with uses the collection of danger vital signs and complaint category to notify the nurse of the possibility of sepsis and to consider drawing blood cultures, a serum lactate, fluid resuscitation and antibiotics within three hours. This system prints out an extra triage sheet to bring attention about the possibility of sepsis to the other caregivers, including the physician.

Also in triage, we have a clinical decision support system in place to evaluate any of our patients that present with the chief compliant of ‘overdose’, ‘psych’ or ‘depression’. With any of these chief complaints, the system automatically asks the nurse three questions in relation to safety of the patient; a yes to any one of the three questions directs the nurse to implement a patient safety attendant to ensure the safety of the patient and the staff.

The last clinical support system through triage is our fall risk protocol. At the end of each triage process, criteria come up on the screen to help the nurse determine the fall risk of the patient. If it is chosen that the patient is a fall risk, interventions such as a sign on the patients door are displayed for the nurse to implement.

During direct patient care, we have a critical lab value alert system that allows us to be notified of critical values that our patients have in their results. This system is easily noticed, demonstrated by a black box on the tracking system. Lab alerts must be accepted with comments noted prior to any disposition of a patient, ensuring that the nurse and doctor communicate about these values.

Prior to discharge, we have a system through tandem that forces us to review medications and vital signs. This system helps us with patient care in two ways. First, it allows us to review all medications that were given to the patient, it ensures that we put stop times on all fluids and antibiotics, and it allows us to evaluate as to whether the patient is ready for discharge or within the hour monitoring window of narcotic administration. Second, the system serves as a reminder to document a discharge set of vital signs, and to notify the physician if those vital signs are abnormal in any way.

In addition to these ‘cues’ that are present in my clinical decision making, support systems are also in place for other reasons. We have an antibiotic helper that can guide physicians through the selection and dose of antibiotics. We also have an Emergency Department sepsis protocol that can help guide both physicians and nurses to the interventions required on septic patients. Clinical decision support systems are there to provide help and resources to care givers. Through the readings, I have realized how important these support systems are. In today’s busy healthcare world, support systems are vital to ensure that important information does not go unnoticed.

References

Courtney K. L., Alexander G.L. & Demiris, G. (2008). Information technology from novice to expert: Implementation implications. Journal of Nursing Management, 16(6), 692-699.