DNP 805 Topic 3 DQ 2 Select a particular medication or clinical problem
Topic 3 DQ 2
Apr 28-May 2, 2022
Select a particular medication or clinical problem. Describe how the CPOE and/or CDSS technologies support care decisions in this area.
REPLY TO DISCUSSION
Patient safety is a crucial problem in the healthcare setting. As a result, multiple stakeholders must employ measures that assure patient safety and effective patient service. Some of these issues are clinical or medication-related. In recent years, technology has played an important part in resolving these issues. The clinical decision support system and the computerized physician order entry system, in particular, have been in the forefront of resolving drug and clinical issues (Sutton et al., 2020).
One example of how the two technologies can be integrated for better outcomes is in the case of a critically ill patient or people living with multiple conditions. Such people frequently require a variety of drugs and tests. As a result, the number of treatments and orders for these patients is significant, increasing the possibility of confusion and drug errors (Liu et al., 2020). In such a case, a computerized physician order entry system could be crucial in organizing and updating new orders or entries generated by healthcare practitioners. Such enhancements and organization improve the efficiency of patient care. In addition, treatment and drug error rates are reduced, and care quality is improved.
In such a circumstance, the adoption of a clinical decision support system can also be critical. CDSS analyzes data, which is then used to make decisions and improve patient care. Patients who are very ill or have more than one chronic ailment frequently require exceptional care and special attention (Liu et al., 2020). In such circumstances, the use of CDSS is critical because it allows healthcare providers to make better decisions about their care, resulting in improved outcomes.
Liu, S., See, K. C., Ngiam, K. Y., Celi, L. A., Sun, X., & Feng, M. (2020). Reinforcement learning for clinical decision support in critical care: comprehensive review. Journal of Medical Internet Research, 22(7), e18477. https://doi.org/10.2196/18477
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ digital medicine, 3(1), 1-10. https://doi.org/10.1038/s41746-020-0221-y
Patient safety is important in general, and the CDSS systems ensure safety on all levels. When patients in behavioral health are placed in restraints, for example, the system generated CDSS reminds nurses to check the restraints to ensure that the restraints are released Q2H and circulation checks are performed. When an IV is inserted, the system’s CDSS ensures that the IV is properly cared for. When a Foley Cather is inserted, it alerts the nurses to the need for catheter care. Patients on specific medications, such as patches, are reminded and alerted by the system to perform patch checks and document where their patches are placed. If a note is missing documentation, the system flags it and notifies the clinician.
CDSS is so vital that it helps us to take better care of our patients. Maintaining our patient’s safety is our top priority. Patients with renal insufficiency would be required to have renal doses of antibiotics. The CDSS will send alerts to look at the antibiotic doses before administration. Every day we use this technology but never thought t about it. We have the opportunity to educate others bout this technology.
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Clinical decision support systems has greatly influenced health care today. A medication issue that is often overlooked is prescribing the correct antibiotic. Antibiotic prescription plays an imperative role when treating infectious diseases. Studies show that there has been an increase in bacterial resistance rates, making it more complicated to prescribe the correct empiric antibiotic treatment (Metcalfe et al., 2017). With this, different programs are implemented to ensure the rational prescription of antibiotics. Programs such as antibiotic stewardship programs aim to optimize prescription to increase guideline adherence, which may lead to the reduction of antibiotic use (Metcalfe et al., 2017). In a study conducted by Neugebauer and Vogelmann (2020), an antibiotic stewardship program was used to improve the use of antibiotics. The study showed that medical professions indeed require additional tools such as a CDSS to ensure the correct antibiotic was used for particular diseases. The system also provided recommended doses based on the patients age, labs, and other necessary information.
Metcalfe, J., Lam, A., Lam, S. S. H., Clifford, J. ‐ M., & Schramm, P. (2017). Impact of the introduction of computerized physician order entry ( CPOE) on the surveillance of restricted antimicrobials and compliance with policy. Journal of Pharmacy Practice & Research, 47(3), 200–206.
Neugebauer, M. Ebert, & R. Vogelmann. (2020). A clinical decision support system improves antibiotic therapy for upper urinary tract infection in a randomized single-blinded study. BMC Health Services Research, 20(1), 1–10. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-020-5045-6
Thanks for your post, in addition, The CPOE when antibiotics orders are being placed will alert the clinician prior to completing the order of specific task that are needed to be done for this specific drug for example vancomycin or gentamicin, it will alert physician that labs need to be done after completion of the order. Some system will generate the trough and peak orders
as a CDSS whereas another might have to be manually placed as an alert from the CPOE. Some CPOE antibiotic orders will give the specific range of how the antibiotic can be ordered for specific treatments for example BID for 5 days in
comparison to TID for 10 days and will name the specific illness that is being treated so the physician can choose, and the antibiotics is not under prescribed or over prescribed.
Thanks for your post
CDSS is so vital that it helps us to take better care of our patients. Maintaining our patient’s safety is our top priority. Patients with renal insufficiency would require to have renal doses of antibiotics. The CDSS will send alerts to look at the antibiotic doses before administration.Every day we use these technology but never thought thought about it.We have the oppourtunity to educate others bout this technology.
Thanks for your post
I now have a better understanding of the CDSS. I agree with the CDSS allowing for the right dose of antibiotic doses. Especially the renal patients with compromised renal functions would require renal doses. The CDSS would alert the physician when ordering medications such as vancomycin to ensure that the correct dose is ordered. In addition, the pharmacist would receive alerts and if the physicians order the wrong dose, then the pharmacist would advise the physicians to order the appropriate dose.
CDSS is excellent at positively influencing the care delivery system by improving the efficiency of care processes and enhancing all safety measures embedded in all HIT tools used by the HCP. The clinical information and parameters that have been set or programmed are used by the CDSS to provide clinical decision support to the HCP. The CDSS assists with care decisions based on standardized controlled data that is entered based on the system’s knowledge base, reasoning capacity, and communication output. As a result, the commonly used adage “garbage in, garbage out” applies. The CDSS would only make a decision based on what had been programmed and what had been documented.
For instance, in the area of registration to admit patients into the hospitals. The registrar’s office in the emergency room has a tendency of not updating the information in the records. We find that most times, the patients do not have the correct address or the correct phone number, or there is no emergency contact, sometimes, to move forward they enter the patients name as the emergency contact and this causes a problem when there is an emergency situation and the hospital cannot contact anyone because no one has come to see the patient or no one realized that there was no true emergency contact listed and the worse is that sometimes the listed emergency contact is someone that has died maybe one or two years prior. The CDSS can support care here if there is a trigger that makes them enter new information rather than relying on the old information. It will prevent the delays with trying to find family members to consent to a procedure when it is not an emergency.
The CDSS when it is used for cardiovascular disease preventive measures, it can be used as a screening mechanism to remind the HCP to screen for certain risk factors and asking a series of questions on how they adhere to their medications and the type of treatments they have utilized and recommendations for certain health behavior modifications. For instance, In South Omaha Medical Associates (SOMA), they have a high percentage of low-income patients more that they have clinics, so they performed an assessment, in collaboration with other health departments and they realized that they needed to increase their use of EHR and implement CDSS. This has helped them to identify patients who were undiagnosed with risk factors for cardiovascular diseases. With the use of CDSS, they increase their monitoring of quality measures and self-measuring of blood pressures which has improved their workflow and led to a 25% rise in patients coming to the clinic and improved patient safety outcomes (CDC, 2020).
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