October 1st, 2015
Our long-term goal is to ensure nurse clinical decision support (CDS) works as intended before full deployment in clinical practice. As part of a broader effort, this pilot explores factors influencing acceptance/non-acceptance of 8 CDS suggestions displayed through selecting a blinking red button in an electronic health record (EHR) based nursing plan of care software prototype. A diverse sample of 21 nurses participated in this high fidelity clinical simulation experience and completed a questionnaire to assess reasons for accepting/not accepting the CDS suggestions. Of 168 total suggestions displayed during the experiment (8 for each of the 21 nurses), 123 (73.2%) were accepted and 45 (26.8%) were not accepted. The mode number of acceptances by nurses was 7 of 8 with only 2 of 21 nurses accepting all. The main reason for CDS acceptance was the nurse’s belief that the suggestions were good for the patient (n=100%) with other features being secondarily reinforcing. Reasons for non-acceptance were less clear, with under half of the subjects indicating low confidence in the evidence. This study provides preliminary evidence that high-quality simulation and targeted questionnaires about specific CDS selections offer a cost-effective means for testing before full deployment in clinical practice.
Keywords: electronic health records; nursing care plans; standardization; clinical decision support systems; simulation lab
Sousa, V. E. C., Dunn Lopez, K.,, Febretti, A,, Stifter, J., Yao, Y., Johnson, A., Wilkie, D. J., Keenan, G. M., Use of Simulation to Study Nurses’ Acceptance and Nonacceptance of Clinical Decision Support Suggestions, CIN: Computers, Informatics, Nursing, vol 33, no 10, pp. 465–472, October 1st, 2015. https://doi.org/10.1097/CIN.0000000000000185