实施注册护士驱动的临床决策支持对抗生素管理的障碍:回顾性案例研究
Elizabeth R Stevens1, Lynn Xu1, JaeEun Kwon1
1Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States.
JMIR formative research
|May 23, 2024
概括
实施初级保健护士的临床决策支持面临重大障碍,包括人员短缺和不同的国家政策. 解决工作流程和文化差异是采用新工具的关键.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 实施科学 实施科学
- 临床信息学 临床信息学
背景情况:
- 高达50%的针对上呼吸道感染 (URI) 的抗生素处方是不适当的.
- 临床决策支持 (CDS) 系统在电子健康记录中未得到充分利用,以减轻不必要的抗生素使用.
研究的目的:
- 评估实施电子健康记录集成临床预测规则 (iCPR) 的障碍,对注册护士 (RN) 进行CDS干预,委托对URI患者进行护理.
- 了解在多个卫生系统的随机控制阶段试验中的实施挑战.
主要方法:
- 使用定量和定性数据 (采访,调查,图表评论) 的回顾性案例研究.
- 在实施研究综合框架 (CFIR) 的指导下,描述障碍.
- 对编码为缺失,中立,弱或强的实施因素的分析.
主要成果:
- 在所有CFIR领域中确定了障碍,外部环境 (例如COVID-19影响,当地条件) 构成了最强大的挑战.
- 内部设置障碍包括人员变更,RN短缺,竞争的责任,以及RN实践范围的不同国家政策.
- 工作流冲突,有限的资源,可选的参与和缺乏激励因素也阻碍了实施.
结论:
- 医疗保健系统工作流程和文化中的显著变化影响了干预措施的采用.
- 学习的经验可以为其他RN委托协议实现CDS工具提供信息.
- 系统范围的干预需要考虑国家,卫生系统,实践以及文化和工作流程中的个人层面的变化.
关键词:
在CDS中,CDS是指CDS.基于CDS的干预是基于CDS的干预在CFIR中,CFIR是最重要的.实施研究的综合框架研究研究欧洲人权理事会 欧洲人权理事会在纽约,纽约.这是一个RN RN RN.在RN短缺方面.在RN短缺的情况下,RN短缺.由RN驱动的RN驱动的由RN驱动的干预是指RN驱动的干预.患有急性呼吸道感染.急性呼吸道感染急性呼吸道感染抗生素抗生素是一种抗生素.抗生素管理的管理.抗生素 抗生素是一种抗生素.屏障障碍物 屏障障障碍物 屏障障障碍物障碍物 障碍物 障碍物查看图表查看图表 查看图表临床决策支持 临床决策支持在临床环境中.在临床护理环境中.决策支持提供了决策支持.有效性 有效性.电子健康记录 电子健康记录电子健康记录是电子健康记录.卫生系统 卫生系统实施实施实施实施实施.基础设施基础设施基础设施的基础设施.基础设施基础设施的基础设施.综合性临床预测规则面试 面试 面试 面试 面试面试 面试 面试 面试法律是法律,法律是法律.法律法规 法律法规 法律法规护士护士护士是什么意思护士 护士 护士人员的可用性,人员的可用性.政策 政策 政策 政策政策 政策 政策 政策处方 处方 处方 处方 处方处方 处方是一种处方.注册护士是注册护士,注册护士是注册护士.研究人员研究员研究员研究人员研究人员研究人员研究人员研究人员研究人员.追溯分析是一种回顾性分析.工作人员变更 工作人员变更人员变化 工作人员的变化公司营业额 营业额紧急护理 紧急护理工作流变化的可变性.
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