Measuring the Effect of Clinical Decision Support on Nursing EBP

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Primary Author:</td>
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Susan Cortez, RN, BSN, MBA/ HCM, PhD</td>
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Co-Principal Investigators/Collaborators:</td>
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Nancy Wells RN, DNSc, PhD</td>
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Organization:</td>
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Vanderbilt University Medical Center</td>
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Abstract</h2>
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Purpose</h3>
<p>The research purpose was to measure the effect of active Clinical Decision Support (CDS) on oncology nurses’ use of evidence-based interventions for symptom control.</p>
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Background</h3>
<p>Rates of oncology nursing evidence-based practice range from 41 to 50%, due, in part, to lack of quick and easy access to evidence-based interventions during nurse-patient interaction. Clinical Decision Support embedded within the electronic documentation system may address this barrier.</p>
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Materials & Methods</h3>
<p>This design was a longitudinal cluster randomized study with 2 oncology infusion clinics in the intervention group and 2 in the control group. The study intervention was active CDS, in the form of drop down boxes for 4 common symptoms – constipation, diarrhea, fatigue, and pain. Education sessions on the Oncology Nursing Society’s “Putting Evidence Into Practice” evidence-based interventions were offered for all nurses. The research outcome was adherence to evidence-based interventions, obtained using manual record review. The sample observations, pulled from the enterprise data warehouse (EDW), were documented interventions for cancer-related symptoms. Two hundred observations were pulled at baseline, post-education, and post-intervention yielding a total sample of 600. Mixed model linear statistical analysis was used to test the difference in use of evidence-based interventions between the intervention and control groups for each sample cycle.</p>
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Results</h3>
<p>Chai Square analysis showed no statistically significant differences between groups on nursing education or years of clinical experience (p > 0.05). The average rate of intervention adherence at baseline was 27% across both groups. After education, the average rate increased to 36.5% and then decreased to 26% following the CDS intervention. The mixed model analysis showed no interaction between the groups and sample cycle (F(df=2,593)= 1.37, p= .26), suggesting active CDS did not improve use of evidence-based interventions.</p>
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Conclusion</h3>
<p>Active CDS did not alter the nurse’s use of evidence-based interventions compared to controls. Further investigation of active CDS with additional interactive strategies is warranted.</p>
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<p>© Improvement Science Research Network, 2012</p>
<p>The ISRN published this as received and with permission from the author(s).</p>