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Converting interruptive alerts to noninterruptive clinical decision support (CDS) tools improved compliance with peripherally inserted central catheter (PICC) dressing change protocols. This enhanced patient care by reducing overdue dressing changes and eliminating manual tracking.

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Area of Science:

  • Clinical Informatics
  • Healthcare Quality Improvement
  • Patient Safety

Background:

  • Interruptive alerts contribute to clinician alert fatigue, necessitating evaluation of poorly performing alerts for alternative solutions.
  • An interruptive alert for peripherally inserted central catheter (PICC) dressing changes had low actionability, with only 1.7% of 617 alerts acted upon over six months.

Purpose of the Study:

  • To improve compliance with institutional PICC dressing change protocols by converting a poorly functioning interruptive alert to a noninterruptive alert.
  • To measure the impact of this change on the percentage of initial PICC dressing changes occurring beyond the recommended 48-hour timeframe.
  • To assess the time to the first dressing change and evaluate the replacement of manual patient list tracking with the new system.

Main Methods:

  • A clinical informatics team collaborated with stakeholders to analyze clinical workflows and identify needs for tracking patients requiring dressing changes.
  • A noninterruptive clinical decision support (CDS) tool, integrated into the patient list column, was developed to replace the existing interruptive alert.
  • A pre-postintervention mixed-methods cohort study was conducted from January 2022 to November 2022 to evaluate the intervention's effectiveness.

Main Results:

  • The percentage of patients with overdue PICC dressing changes significantly decreased from 21.9% to 7.8% (p < 0.001).
  • The mean time to the first PICC dressing change was reduced from 40.8 hours to 30.7 hours (p = 0.02).
  • The new CDS tool achieved universal adoption, and clinicians ceased using the manual patient list for tracking.

Conclusions:

  • This case report demonstrates that a population-based, noninterruptive CDS tool integrated into the patient list column can improve adoption and compliance.
  • The findings suggest that providing desired functionality within a noninterruptive CDS format can be effective, contrary to some previous reports.
  • The successful implementation highlights a viable strategy for optimizing alert systems and improving adherence to clinical protocols.