DNP 805 Topic 3 Discussion 1
DNP 805 Topic 3 Discussion 1
Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice. Identify one element of either the or CDSS you would improve that could enhance the effectiveness of the system for that patient population.
Incorrect medication orders in clients with reduced renal clearance have a high risk of causing serious side effects (Desmedt et al 2018). Clinical pharmacists were formerly relied on to manually check laboratory data and warn physicians when clients’ drug levels were high or at levels that required intervention such as altering a drug dose, increasing, reducing, discontinuing, or starting a new one. The physician would then manually alter the order based on the recommendations (Desmedt et al 2018). With the introduction of the EHR, CDSS are now included in the CPOE, and this involuntarily matches the order with the appropriate dose that is recommended taking into account the Glomerular Filtration Rate (GFR), identifies any controversies with the dosing, and if any arise, sends an alert or reminder to the doctor of the patient’s kidney clearance and the dose that is proposed for the kidney clearance result (Desmedt et al 2018).
Furthermore, the notifications clarify the consequences of not adjusting the doses. If alerts are not followed, the pharmacist can now observe these changes in the system, which is a wonderful method to keep accountability for modifications and the potential outcomes for the client. CDSS were developed to establish the baseline in automated systems of the patient’s renal function via the EHR and have been shown to aid in the early detection of acute kidney injury (Al-Jaghbeer et al, 2018).
CDSS integration in CPOE reduces knowledge-based errors, rule-based errors, and slips (Alexander, Frith & Hoy, 2019). It includes drug interaction, identical treatment, and renal dosage adjustment warnings. It provides up-to-date information about a person as well as personalized recommendations for better care. As a result, one strategy used to improve the suitability of medicine orders in clients with documented renal impairments is CDSS (Desmedt et al 2018). When used correctly, CDSS can reduce the length of hospital stay, the need for dialysis, and mortality associated with renal disorders (Al-Jaghbeer et al, 2018).
Despite the fact that CPOE and CDSS are intertwined and embedded in the EHR, clinicians may ignore or overrule signals. The high override rates of some physicians have been attributed to alert weariness, alert severity, and workload (Ancker et al, 2017). CDSS must be constantly evaluated and adjusted as new approaches become available. Drug-guided dosage algorithms have proven to be useful in improving how we create orders for customers with renal issues. These algorithms provide an acceptable link between dose and renal function, making it more difficult to override an alarm. Furthermore, if notifications are consistently ignored and overridden, investigations must be conducted.
In some cases, the use of a web-based clinical pharmacist has resulted in improved results and adherence to CDSS recommendations, such that alerts are not ignored. Overall, continual education for all clinicians to avoid unnecessary overriding alerts would be beneficial (Desmedt et al 2018). Clients with a history of kidney disease can benefit from integrating the clinical decision support system (CDSS) to the EHR’s computerized physician order entry (CPOE) to improve the suitability of a drug order (Desmedt et al 2018).
Read Also:
References
Al-Jaghbeer, M., Dealmeida, D., Bilderback, A., Ambrosino, R., & Kellum, J. A. (2018). Clinical Decision Support for In-Hospital AKI. Journal of the American Society of Nephrology: JASN, 29(2), 654–660.
Alexander, S., Frith, K. H., & Hoy, H. (Eds.). (2019). Applied clinical informatics for nurses (2nd Ed.). Jones & Bartlett Learning. ISBN-13: 9781284129175
Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., Kaushal, R., & with the HITEC Investigators (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC medical informatics and decision making, 17(1), 36.
Desmedt, S., Spinewine, A., Jadoul, M., Henrard, S., Wouters, D., & Dalleur, O. (2018). Impact of a clinical decision support system for drug dosage in patients with renal failure. International journal of clinical pharmacy, 40(5), 1225–1233.
Name: Discussion Rubric
| Excellent
90–100 |
Good
80–89 |
Fair
70–79 |
Poor
0–69 |
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| Main Posting:
Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. |
40 (40%) – 44 (44%)
Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. |
35 (35%) – 39 (39%)
Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. |
31 (31%) – 34 (34%)
Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. |
0 (0%) – 30 (30%)
Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. |
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| Main Posting:
Writing |
6 (6%) – 6 (6%)
Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
5 (5%) – 5 (5%)
Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
4 (4%) – 4 (4%)
Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. |
0 (0%) – 3 (3%)
Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. |
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| Main Posting:
Timely and full participation |
9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation. Posts main Discussion by due date. |
8 (8%) – 8 (8%)
Meets requirements for full participation. Posts main Discussion by due date. |
7 (7%) – 7 (7%)
Posts main Discussion by due date. |
0 (0%) – 6 (6%)
Does not meet requirements for full participation. Does not post main Discussion by due date. |
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| First Response:
Post to colleague’s main post that is reflective and justified with credible sources. |
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting. |
7 (7%) – 7 (7%)
Response is on topic and may have some depth. |
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth. |
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| First Response:
Writing |
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. |
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| First Response:
Timely and full participation |
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. Posts by due date. |
4 (4%) – 4 (4%)
Meets requirements for full participation. Posts by due date. |
3 (3%) – 3 (3%)
Posts by due date. |
0 (0%) – 2 (2%)
Does not meet requirements for full participation. Does not post by due date. |
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| Second Response: Post to colleague’s main post that is reflective and justified with credible sources. |
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting. |
7 (7%) – 7 (7%)
Response is on topic and may have some depth. |
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth. |
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| Second Response: Writing |
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. |
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| Second Response: Timely and full participation |
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. Posts by due date. |
4 (4%) – 4 (4%)
Meets requirements for full participation. Posts by due date. |
3 (3%) – 3 (3%)
Posts by due date. |
0 (0%) – 2 (2%)
Does not meet requirements for full participation. Does not post by due date. |
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| Total Points: 100 | ||||||
Name: Discussion Rubric
