Evaluating clinical decision rules

Clinical decision rules (CDRs) are decision support tools that synthesize evidence into bedside tools for practice. Before adopting CDRs into practice, nurses must be assured that there is sufficient evidence in the literature that the rule performs as expected, can do so in a variety of settings (especially in settings similar to one's own), and that using it will likely result in improved patient outcomes at no additional cost (or conversely, that it will lower costs with no adverse effect on clinical outcomes). This article provides a framework for clinical nurses to evaluate CDRs. The framework focuses on the processes used to establish the external validity of the rule, and the evidence that using the rule results in improved patient or systems outcomes, including cost-effectiveness. The Braden Scale is used as an example and is evaluated using the framework described.