Using Clinical Decision Support Systems to Decrease Intravenous Acetaminophen Use: Implementation and Lessons...

Area of Science:

• Healthcare Informatics
• Clinical Quality Improvement
• Pediatric Hospital Medicine

Background:

• Clinical decision support systems (CDSS) offer potential benefits for medical decision-making but can also lead to unintended harm.
• Their effectiveness is not universal, necessitating careful implementation and evaluation.

Purpose of the Study:

• To describe the implementation of an unsuccessful interruptive CDSS aimed at optimizing intravenous (IV) acetaminophen use in a pediatric hospital.
• To identify lessons learned from this implementation, focusing on end-user acceptability and impact on care.

Main Methods:

• A quality improvement methodology was employed, implementing an interruptive CDSS with a 24-hour expiry for IV acetaminophen orders.
• Primary outcomes measured IV acetaminophen administrations per 1,000 patient days pre- and post-implementation.
• Process and balancing measures included order rates, provider/nursing acceptability, and unintended consequences via surveys.

Main Results:

• No significant change in hospital-wide IV acetaminophen administrations or orders was observed post-implementation or after CDSS removal.
• Nearly half of the 88 survey respondents reported negative impacts on patient care, citing delays and reduced efficiency.
• Low end-user acceptability was a key factor in the CDSS's lack of success.

Conclusions:

• Monitoring CDSS implementation and incorporating end-user acceptability are critical for success.
• Teams must be prepared to adapt or remove CDSS that fail to meet goals or have low user acceptance.
• Careful implementation and ongoing evaluation are essential to maximize CDSS benefits and minimize harm in clinical practice.