Lessons from the implementation of a near patient anticoagulant monitoring service in primary care.
OBJECTIVE: To evaluate the implementation of a primary care, nurse-led, near patient anticoagulant monitoring service. DESIGN: Action research workshops, supported by questionnaires and clinical audit, to define the strengths and weaknesses of the service and the effectiveness of the computerised de...
| Publicado en: | Informatics in Primary Care Vol. 12; no. 1; pp. 27 - 34 |
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| Autores principales: | , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Radcliffe Publishing
Mar2004
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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=106587700&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106587700 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14760320 NAN jtl: Informatics in Primary Care issn: 14760320 maglogo: N pubinfo: dt: Mar2004 vid: 12 iid: 1 pid: 13723 pub: Radcliffe Publishing artinfo: ui: 106587700 106587700 109613955 NLM15140350 106587700 ppf: 27 ppct: 7 formats: tig: atl: Lessons from the implementation of a near patient anticoagulant monitoring service in primary care. aug: au: de Lusignan S Singleton A Wells S affil: Senior Lecturer, Primary Care Informatics, Department of Community Health Sciences, St. George's Hospital Medical School, London SW17 0RE, UK; slusigna@sghms.ac.uk sug: subj: Drug Monitoring Anticoagulants Therapeutic Use Primary Health Care Administration Drug Monitoring Nursing Audit Decision Making, Computer Assisted Action Research Funding Source Questionnaires Human ab: OBJECTIVE: To evaluate the implementation of a primary care, nurse-led, near patient anticoagulant monitoring service. DESIGN: Action research workshops, supported by questionnaires and clinical audit, to define the strengths and weaknesses of the service and the effectiveness of the computerised decision support system used to set the dosage of anticoagulant and time interval to the next appointment. SETTING: 13 general practices that implemented anticoagulant monitoring in a primary care organisation in south east England. PARTICIPANTS: 18 practice nurses, 72% of whom had over 20 years' clinical experience; the university-based investigators and managers from the primary care organisation. MAIN OUTCOME MEASURE: The nurses felt that the patients preferred the practice-based service, finding it more personal and accessible. However, circumstances arose where the nurse's intuition had to override the software's advice. The nurses found it stressful when they were unclear whether their decision making represented acceptable variation or dangerous practice. An audit tool was developed to measure the extent to which there was variation from the software's recommendation, and patterns of variation emerged. Most evident was that nurses responded to uncertainty by practising cautiously, shortening the interval until the next visit and slightly reducing the recommended dose of warfarin. CONCLUSIONS: The group, by sharing their experiences through a structured series of workshops, developed an understanding of when it might be appropriate to vary from the decision support software's recommendations and how this could be audited. The technological solution modelled on hospital practice proved hard to implement in primary care. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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