Characteristics and effects of nurse dosing over-rides on computer-based intensive insulin therapy protocol performance.
Objective: To determine characteristics and effects of nurse dosing over-rides of a clinical decision support system (CDSS) for intensive insulin therapy (IIT) in critical care units.Design: Retrospective analysis of patient database records and ethnographic study of nurses using IIT CDSS.Measuremen...
| Publicado en: | Journal of the American Medical Informatics Association Vol. 18; no. 3; pp. 251 - 259 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Oxford University Press / USA
May2011
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104872431&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104872431 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10675027 FZ9 jtl: Journal of the American Medical Informatics Association issn: 10675027 maglogo: N pubinfo: dt: May2011 vid: 18 iid: 3 pid: 622 pub: Oxford University Press / USA artinfo: ui: 104872431 NLM21402737 2011012890 10.1136/amiajnl-2011-000129 NLM21402737 PMC3078667 104872431 ppf: 251 ppct: 8 formats: tig: atl: Characteristics and effects of nurse dosing over-rides on computer-based intensive insulin therapy protocol performance. aug: au: Campion TR Jr May AK Waitman LR Ozdas A Lorenzi NM Gadd CS Campion, Thomas R Jr May, Addison K Waitman, Lemuel R Ozdas, Asli Lorenzi, Nancy M Gadd, Cynthia S affil: Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA sug: subj: Decision Support Systems, Clinical Dosage Forms Drug Therapy, Computer Assisted Insulin Administration and Dosage Nursing Practice Adult Attitude to Computers Female Guideline Adherence Hypoglycemia Prevention and Control Intensive Care Units Male Middle Age Retrospective Design Tennessee Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: Objective: To determine characteristics and effects of nurse dosing over-rides of a clinical decision support system (CDSS) for intensive insulin therapy (IIT) in critical care units.Design: Retrospective analysis of patient database records and ethnographic study of nurses using IIT CDSS.Measurements: The authors determined the frequency, direction-greater than recommended (GTR) and less than recommended (LTR)- and magnitude of over-rides, and then compared recommended and over-ride doses' blood glucose (BG) variability and insulin resistance, two measures of IIT CDSS associated with mortality. The authors hypothesized that rates of hypoglycemia and hyperglycemia would be greater for recommended than over-ride doses. Finally, the authors observed and interviewed nurse users.Results: 5.1% (9075) of 179,452 IIT CDSS doses were over-rides. 83.4% of over-ride doses were LTR, and 45.5% of these were ≥ 50% lower than recommended. In contrast, 78.9% of GTR doses were ≤ 25% higher than recommended. When recommended doses were administered, the rate of hypoglycemia was higher than the rate for GTR (p = 0.257) and LTR (p = 0.033) doses. When recommended doses were administered, the rate of hyperglycemia was lower than the rate for GTR (p = 0.003) and LTR (p < 0.001) doses. Estimates of patients' insulin requirements were higher for LTR doses than recommended and GTR doses. Nurses reported trusting IIT CDSS overall but appeared concerned about recommendations when administering LTR doses.Conclusion: When over-riding IIT CDSS recommendations, nurses overwhelmingly administered LTR doses, which emphasized prevention of hypoglycemia but interfered with hyperglycemia control, especially when BG was >150 mg/dl. Nurses appeared to consider the amount of a recommended insulin dose, not a patient's trend of insulin resistance, when administering LTR doses overall. Over-rides affected IIT CDSS protocol performance. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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