使用内置的临床决策支持来改善酸盐补充实践:一个准实验性研究
Joint Commission journal on quality and patient safety
|September 20, 2024
概括
使用临床决策支持 (CDS) 的电子健康记录 (EHR) 干预措施显著减少了静脉注射 (IV) 酸盐过度使用在患有低酸血症的患者中. 这种有针对性的方法改善了护理,减少了不必要的IV补充超过50%.
科学领域:
- 临床信息学 临床信息学
- 药理学 药理学是指药理学的学科.
- 医院管理局 医院管理局
背景情况:
- 住院血清酸盐替代实践表现出显著的变化,导致过度使用.
- 电子健康记录 (EHR) 与临床决策支持 (CDS) 的干预可以标准化护理并减少不必要的治疗.
- 过度使用低酸血症纠正有助于增加医疗保健成本和潜在的患者伤害.
研究的目的:
- 在EHR系统中实施和评估CDS工具,以减少过度使用静脉 (IV) 补充剂.
- 根据既定的临床指导方针,指导临床医生采取适当的酸盐补充策略.
- 为了减少不必要的IV酸盐的发病率在一个大的安全网医疗保健系统.
主要方法:
- 改进了现有的EHR订单集,用于用CDS填充酸盐,并纳入基于严重性的指导和简化订单.
- 在EHR中实施最佳实践咨询 (BPA),以提醒临床医生,当IV被要求用于轻度/中度低度血症时,没有零人数 (NPO) 状态.
- 测量了主要结果:在没有NPO订单的轻度至中度低血症患者中,IV酸盐替代率 (1.0-1.9 mg/dL) 每1000个患者日.
主要成果:
- 在没有NPO订单的情况下,轻度至中度低度血症的IV酸盐替代减少了53.0% (从7.22到3.40每1000个患者日;p < 0.001).
- 同时,这个患者群体的口服酸盐替代剂增加了38.8% (每1000个患者日从6.39到8.87;p<0.001).
- 在患者酸盐水平≥2.0 mg/dL的IV和口服酸盐替代剂中也观察到显著的减少.
结论:
- 采用CDS的双边EHR干预有效地减少了在轻度至中度低度患者的住院IV酸盐替代53.0%的患者.
- 干预成功地将治疗模式转移到更合适的补充策略,在大型安全网环境中.
- 集成到EHR系统中的CDS工具对于优化临床实践和减少药物过度使用是有价值的.
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