NR 599 Week 5: Clinical Decision Support Systems
Chamberlain University NR 599 Week 5: Clinical Decision Support Systems– Step-By-Step Guide
This guide will demonstrate how to complete the Chamberlain University NR 599 Week 5: Clinical Decision Support Systems assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NR 599 Week 5: Clinical Decision Support Systems
Whether one passes or fails an academic assignment such as the Chamberlain University NR 599 Week 5: Clinical Decision Support Systems depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NR 599 Week 5: Clinical Decision Support Systems
The introduction for the Chamberlain University NR 599 Week 5: Clinical Decision Support Systems is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for NR 599 Week 5: Clinical Decision Support Systems
After the introduction, move into the main part of the NR 599 Week 5: Clinical Decision Support Systems assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NR 599 Week 5: Clinical Decision Support Systems
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NR 599 Week 5: Clinical Decision Support Systems
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NR 599 Week 5: Clinical Decision Support Systems
| Pros | Cons |
| Provide clinicians with filtered knowledge to enhance healthcare (Zikos & Delillis, | CDS tools could have unintended consequences such as leading a clinician to think there are no other alternatives than what is suggested by the tool. |
| Improve patient Safety – alerts to reduce errors, promotes adherence to clinical initiatives like DVT prophylaxis and cardiac mortality prevention strategies | Provider resistance – implementing new CDS technology that a provider may feel affects their timing and autonomy, affecting their workflow. |
| Support clinician workflow – Encourages providers to do the right thing at the right time with the correct interventions | Affects autonomy of providers if the alerts in the CDS are “hard stops”, and prevent them from moving forward in the system until an alert is addressed. |
| Promote patient education- quick access to education tools and referral links increase patient engagement in diagnosis | Legal Implications- Malpractice risk and legal implications to providers using CDS and not acting on an alert. |
Pratt et al (2022) writes that there is a 40% lifetime risk of diabetes development in one’s lifetime. As primary care providers, our role is to engage patient in interventions to help reduce their risk of developing diabetes. Regularly these patients are missed in screening when they have risk factors to diabetes. CDS could be a powerful tool to collect data and alert providers to patients increased risk. This clinical example below highlights an example of utilizing this CDS tool in practice:
A 47-year-old, female patient presents to her primary care office for her annual physical examination. Prior to her appointment she has basic labs, hemoglobin A1c, lipid panel drawn, and results uploaded into this system. She fills out a questionnaire about her current health habits in the waiting room and then gets checked into her exam room after getting her height, weight and vital signs checked. The EHR information in the system flags this patient as eligible for the Pre-DM CDS algorithm. (Pratt et al, 2022). A best practice alert appears on the screen that the patient displays information to the provider. This includes her last three measurements of weight, BMI, hemoglobin A1C, fasting glucose, creatinine and random glucose. The CDS guides the provider to add prediabetes code to the problem list, prescribe metformin if appropriate, and order additional labs as needed (Obrien et al, 2022). The tool also suggests a link to be clicked on to refer the patient to a health educator to discuss healthy lifestyle changes.
According to the CDC (2022), only 15.3% of patients with prediabetes report being told by a provider that they have this condition. Utilizing this CDS will help to initiate the conversation between the provider and the patient and ideal promote early interventions to reduce the development of diabetes. After following the Pre-DM CDS tool to completion, patient education generated from the EHR with patient specific information on it, can be handed to the patients or sent electronically during this appointment to begin the conversation and treatment plan.
Centers for Disease Control and Prevention. National Diabetes Statistics Report, Estimates of Diabetes and Its Burden in the United States. 2022; https://www.cdc.gov/diabetes/data/statistics-report/index.htmlLinks to an external site.. Accessed April 8, 2022.
O’Brien, M. J., Vargas, M. C., Lopez, A., Feliciano, Y., Gregory, D. L., Carcamo, P., Mohr, L., Mohanty, N., Padilla, R., Ackermann, R. T., Persell, S. D., & Feinglass, J. (2022). Development of a novel clinical decision support tool for diabetes prevention and feasibility of its implementation in primary care. Preventive Medicine Reports, 29, 101979. https://doi.org/10.1016/j.pmedr.2022.101979Links to an external site.
Pratt, R., Saman, D. M., Allen, C., Crabtree, B., Ohnsorg, K., Sperl-Hillen, J. A. M., Harry, M., Henzler-Buckingham, H., O’Connor, P. J., & Desai, J. (2022). Assessing the implementation of a clinical decision support tool in primary care for diabetes prevention: A qualitative interview study using the Consolidated Framework for Implementation Science. BMC Medical Informatics and Decision Making, 22(1). https://doi.org/10.1186/s12911-021-01745-xLinks to an external site.
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Sample Answer 2 for NR 599 Week 5: Clinical Decision Support Systems
While providers cannot fully rely on CDS tools to make decisions, when they are designed in alignment with the provider’s preferences, they can be useful in increasing positive health outcomes for those that are at increased risk for diabetes (Obrien et al, 2022). Obrien et al’s (2022) study showed that providers that used CDS tool for pre-diabetes had increased rates of prescriptions for metformin and lab tests orders for hemoglobin A1C. There were also increased rates of referrals for health counseling for these patients. Taking into consideration the time to learn the system, once providers are competent and have incorporated it into their workflow, it certainly can help initiate the conversation with the patient about their diagnosis and early interventions to reduce the progression of diabetes. Shi’s randomized controlled trial showed that while modest, when comparing team-based care alone to care given with CDS “significantly reduced cardiovascular risk factors in patients with diabetes,” (Shi et al 2023). Without it, most patients could possibly not be even informed that they have prediabetes. I think utilizing this technology appropriately, absolutely makes CDSS a benefit to the care we provide.
O’Brien, M. J., Vargas, M. C., Lopez, A., Feliciano, Y., Gregory, D. L., Carcamo, P., Mohr, L., Mohanty, N., Padilla, R., Ackermann, R. T., Persell, S. D., & Feinglass, J. (2022). Development of a novel clinical decision support tool for diabetes prevention and feasibility of its implementation in primary care. Preventive Medicine Reports, 29, 101979. https://doi.org/10.1016/j.pmedr.2022.101979Links to an external site. Shi, X., He, J., Lin, M., Liu, C., Yan, B., Song, H., Wang, C., Xiao, F., Huang, P., Wang, L., Li, Z., Huang, Y., Zhang, M., Chen, C.-S., Obst, K., Shi, L., Li, W., Yang, S., Yao, G., & Li, X. (2023). Comparative Effectiveness of Team-Based Care With and Without a Clinical Decision Support System for Diabetes Management : A Cluster Randomized Trial. Annals of Internal Medicine, 176(1), 49–58. https://doi.org/10.7326/M22-1950Links to an external site.
Sample Answer 3 for NR 599 Week 5: Clinical Decision Support Systems
| PROS AND CONS OF CDSS | |
| Pros of CDSS | Cons of CDSS |
| 1 The use of CDSS increases patient safety: CDSS is a computer-based that sifts through tons of Data in real time to provide the health care provider with the most accurate and practical options for treatment. This system uses Data to prevent polypharmacy and possible drug-to-drug interaction, side effects, or practical, safe drug combinations. | 1: CDSS can compromise clinician judgment: CDSS is based on data and evidence based on the data imputed in the system. For a provider to effectively provide care, there must be a relationship between Evidenced bas and clinician judgment. The CDSS system sometimes makes it tasking for providers to bypass the alarms arising from a provider not agreeing with the CDSS options. It can sometimes be frustrating for providers to bypass alarms or notifications to provide person-centered care. |
| 2CDSS fosters evidence-based practices: The CDSS is programmed to provide clinical information to the provider that relates to evidence-based patient care. This kind of care is effective and ensures compliance by the patient since it is founded on clinical research and evidence. The technology-literate patient will be more compliant with treatment that is an evidence-based clinical decision. | Prescription generation cost: The CDSS can sift through data, make a decision based on evidence from the data and send a prescription to the pharmacy. The prescription can be rejected by either the patient or the insurance due to high cost. This leads to further delay of care and possible non-compliance by the patient |
| 3 CDSS reduces workload and clinician burnout: The use of CDSS is a time and effort saver because the system can discern data in real-time and present interventions or possible treatment suggestions quickly. This helps the provider do more quickly, with less effort, more efficiently, and with less tasking practice. | 3; CDSS can cause alarm fatigue in healthcare providers: The system generates an alarm to alert the Provider of any perceived misjudgment or decision that does not tally with the suggestions of the CDSS system. The Provider has the right to use clinical judgment when providing care to the patient. The CDSS system lacks that ability which can cause the generation of alarms. |
The primary goal of a CDSS is to leverage data and the scientific evidence to help guide appropriate decision making. CDSSs directly assist the clinician in making decisions about specific patients. For this discussion thread post, you are to assume your future role as an APN and create a clinical patient and scenario to illustrate an exemplary depiction of how a CDSS might influence your decision. This post is an opportunity for you to be innovative, so have fun!
This morning Mrs. Johnson came into the clinic complaining of pain levels of 8 out of 10 in her legs and arms. The APN performed the physical assessment and ordered some scans to be done on her. During the assessment, Mrs. Johnson did not seem in as much pain as she was verbalizing, and no systemic issues were noted; the APN decided to do a chart check using the CDSS before prescribing pain medications and discovered that Mrs. Johnson has a history for seeking pain meds and suggested other pains relieve measures to assist her. Armed with this information. The APN was able to refer Mrs. Johnson to counseling, a pain management clinic for more specialized care.
Laka, M., Milazzo, A., Carter, D., & Merlin, T. (2021). OP196 Clinical Decision Support Systems (CDSS) For Antibiotic Management: Factors Limiting Sustainable Digital Transformation. International Journal of Technology Assessment in Health Care, 37(S1), 5–5. https://doi.org/10.1017/S0266462321000763Links to an external site.
Shi, X., He, J., Lin, M., Liu, C., Yan, B., Song, H., Wang, C., Xiao, F., Huang, P., Wang, L., Li, Z., Huang, Y., Zhang, M., Chen, C.-S., Obst, K., Shi, L., Li, W., Yang, S., Yao, G., & Li, X. (2023). Comparative Effectiveness of Team-Based Care With and Without a Clinical Decision Support System for Diabetes Management : A Cluster Randomized Trial. Annals of Internal Medicine, 176(1), 49–58. https://doi.org/10.7326/M22-1950Links to an external site.
Sample Answer 4 for NR 599 Week 5: Clinical Decision Support Systems
One of the Pros you listed was reducing costs by not ordering costly lab tests. Lab tests are necessary, but the correct test is not always ordered. Some tests are over used and/or under used. For 2018, spending on laboratory testing in healthcare has been valued at $ 80 billion in the USA, and since 2013, costs for laboratory spending have increased more than 15%, representing the largest increase in utilization of any outpatient procedure. CDSS have shown promising results on improving the appropriateness of clinical study ordering and on reducing overutilization of laboratory tests (Delvaux, et al., 2020).
Reference
Delvaux, N., Piessens, V., De Burghgraeve, T., Mamouris, P., Vaes, B., Vander Stichele, R., Cloetens, H., Thomas, J., Ramaekers, D., De Sutter, A., & Aertgeerts, B. (2020). Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial. Implementation Science, 15(100).
Sample Answer 5 for NR 599 Week 5: Clinical Decision Support Systems
PROS | CONS |
Less medication errors When ordering new medications, CDSS can alert when there’s a drug-drug interaction, or if the patient is allergic to the medication being ordered. This increases patient safety if the person ordering the medication missed it. When giving medications the systems prevent from giving it to the wrong patient or giving the wrong dose.
| Too many alarms Sometimes it can be overwhelming when the systems think there’s an alarm that needs to be shows and it pops up every time the chart is opened. This can be stressful for health care workers. It may cause RNs and MDs to start dismissing notifications regardless of importance (Sutton et al., 2020).
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Documentation A CDS tool is the documentation forms. Everything is condensed into an area where most of what’s going on with the patient is. You can also see previous nurses’ assessments to see if there’s been any change. Quality of documentation can be improved because of CDSS (Sutton et al., 2020).
| Cost CDSS may be costly to keep up with and maintain and keep up to date with changes. |
Event triggered notifications One example is the sepsis alerts. The CDS analyzes the vital signs and alerts the RN of potential sepsis. | Doctor autonomy Clinicians want autonomy and at times the CDSS won’t let them order something they think is needed. They are prevented from moving forward with an order until the alert is addressed (Dramburg et al., 2020) and this can cause a delay in care or take time away from the clinician. |
Clinical Example:
A 30-year-old male comes is admitted to the floor with no significant past medical history. He is allergic to penicillin. He was admitted for a foot wound acquired while on a camping trip when he stepped on some dirty glass. Upon the NP assessing him he has a HR of 115, and a temp of 101.2 F. His labs came back with a WBC of 17. When entering his chart, the first thing that pops up is a sepsis alert with the option to order the sepsis protocol bundle. The NP agrees and orders it and Zosyn is the first antibiotic she attempts to order, but the system alerts that the patient is allergic to penicillin. The NP gathers information from the patient on his previous medication reaction to penicillin, after learning that it was a small rash, the NP decides to continue with Zosyn as the risk is low and premedicate with some Tylenol and Benadryl. This requires the NP to override the CDSS alert.
Dramburg, S., Marchante Fernández, M., Potapova, E., & Matricardi, P. M. (2020). The potential of clinical decision support systems for prevention, diagnosis, and monitoring of allergic diseases. Frontiers in Immunology, 11. https://doi.org/10.3389/fimmu.2020.02116
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for Success. Npj Digital Medicine, 3(1). https://doi.org/10.1038/s41746-020-0221-y
NR 599 Week 6 Midweek Comprehension Questions
As mentioned in this lesson, numerous telecommunications-ready tools are already available to assist nurses in delivering care and improving patients’ health outcomes. New and innovative tools are rapidly making it to the marketplace, making current tools dated and sometimes obsolete. Continue to reflect upon the point-of-care tools you may be familiar with using in your role as a Registered Nurse and how your responsibilities will change with your future role as an APN. How will you stay current? Provide a brief response (100 words or less)
I have used many point-of-care gadgets as a nurse. I may use several resources to engage my patients in their health. Patient portal software makes appointments, provides medical records and results, and allows patient-provider communication and education. This health data organization and sharing system benefits nurses, doctors, and patients.
As an advanced practice nurse, I will provide medication and communicate with patients via mobile apps. I’ll have instant access to patient data and conclusions to quickly address patient concerns. I can save time, calm patients, and improve care by being available outside of office hours. I can manage several patients better with the correct tools. I will review new tools and software to stay current. I will also continue using and educate patients about their many resources.