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Barriers and facilitators to the use of computer-based intensive insulin therapy.

Abstract：

PURPOSE:Computerized clinical decision support systems (CDSSs) for intensive insulin therapy (IIT) are increasingly common. However, recent studies question IIT's safety and mortality benefit. Researchers have identified factors influencing IIT performance, but little is known about how workflow affects computer-based IIT. We used ethnographic methods to evaluate IIT CDSS with respect to other clinical information systems and care processes. METHODS:We conducted direct observation of and unstructured interviews with nurses using IIT CDSS in the surgical and trauma intensive care units at an academic medical center. We observed 49h of intensive care unit workflow including 49 instances of nurses using IIT CDSS embedded in a provider order entry system. Observations focused on the interaction of people, process, and technology. By analyzing qualitative field note data through an inductive approach, we identified barriers and facilitators to IIT CDSS use. RESULTS:Barriers included (1) workload tradeoffs between computer system use and direct patient care, especially related to electronic nursing documentation, (2) lack of IIT CDSS protocol reminders, (3) inaccurate user interface design assumptions, and (4) potential for error in operating medical devices. Facilitators included (1) nurse trust in IIT CDSS combined with clinical judgment, (2) nurse resilience, and (3) paper serving as an intermediary between patient bedside and IIT CDSS. CONCLUSION:This analysis revealed sociotechnical interactions affecting IIT CDSS that previous studies have not addressed. These issues may influence protocol performance at other institutions. Findings have implications for IIT CDSS user interface design and alerts, and may contribute to nascent general CDSS theory.

journal_name

Int J Med Inform

journal_title

International journal of medical informatics

authors

Campion TR Jr,Waitman LR,Lorenzi NM,May AK,Gadd CS

doi

10.1016/j.ijmedinf.2011.10.003

subject

Has Abstract

pub_date

2011-12-01 00:00:00

pages

863-71

issue

12

eissn

1386-5056

issn

1872-8243

pii

S1386-5056(11)00205-X

journal_volume

80

pub_type

杂志文章

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