The Use of Clinical Decision Support to Improve Nursing Practice

Healthcare information technology is solidly entrenched in most acute care hospitals but the need to demonstrate its positive impact on patient outcomes persists. Clinical decision support (CDS) is an informatics tool that is highly customizable to promote patient improvement activities. Despite its high potential, studies have had mixed results regarding the impact of CDS and it has not been widely studied in the realm of nursing practice. One aim of this dissertation was to analyze the concept of CDS in order to inform the examination of the relationships between CDS implementation and nursing interventions. The determining factors of nurses use and acceptance of CDS was also described within the context of the CDS concept schematic developed. Data from 4718 pediatric hospital admissions were analyzed to examine if there was a relationship between the implementation of CDS and the implementation of sequential compression devices (SCD) for the purpose of preventing VTE and the placement of chart notifications of VTE risk. Admissions with patients who were identified as at risk for VTE had SCDs placed almost two and one-half times more often after the CDS was implemented (RR = 2.32; 95% CI (1.9 – 2.83)) and 33 times more likely to have chart notifications placed. In order to describe the determining factors of use, the unified theory of acceptance and use of technology (UTAUT) was adapted to create an electronic survey. Two multivariate regression models were built to describe the UTAUT model from previous literature. Results demonstrated that the model as described explains the majority of the data but also highlighted some weaknesses in the realm of the construct voluntary use. The results of this dissertation contribute to the limited literature regarding CDS use in nursing practice