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Optimization of Nursing-Specific Flu Alerts.

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  • 1Author Affiliations: Duke University School of Nursing, Durham, North Carolina (Drs Cieslowski, Richesson, Silva, and Kim); University of Virginia School of Nursing (Dr Cieslowski); and University of Virginia Medical Center, Charlottesville (Ms Brock).

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Optimizing clinical decision support alerts reduced unnecessary triggers and dismissals, improving influenza vaccination compliance. This workflow enhancement maintained institutional flu vaccination rates effectively.

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Area of Science:

  • Health Informatics
  • Clinical Decision Support Systems
  • Nursing Informatics

Background:

  • Clinical decision support (CDS) interventions like alerts can enhance guideline adherence and patient outcomes.
  • Alert fatigue occurs when excessive or poorly timed alerts are dismissed, diminishing their effectiveness.
  • Nursing-specific alerts for influenza screening and vaccination are prone to triggering issues that impact workflow.

Purpose of the Study:

  • To optimize nursing-specific influenza vaccination alerts to reduce frequency while maintaining compliance.
  • To improve the specificity and usability of clinical decision support alerts within a healthcare setting.
  • To evaluate the impact of redesigned alerts on clinician workflow and vaccination compliance rates.

Main Methods:

  • Analyzed triggering criteria for six influenza vaccine-related alerts.
  • Incorporated nurse end-user feedback and the "five rights" of CDS to redesign alerts.
  • Compared alert activity and compliance rates across two influenza seasons (pre- and post-optimization).

Main Results:

  • Redesigned alerts significantly reduced alerts per encounter (P < .0001) and alert dismissals (P < .0001).
  • Achieved a 2.8% improvement in compliance rates for influenza vaccine screening, documentation, and administration.
  • Focus groups indicated improved workflow, though some users felt alerts still triggered frequently.

Conclusions:

  • Optimizing CDS alert design using a framework like the "five rights" can decrease alert burden and improve outcomes.
  • Redesigned influenza vaccination alerts enhance workflow and compliance, demonstrating the value of user-centered design.
  • Further refinement may be needed to fully address user perceptions of alert frequency.