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Improving the adoption of an electronic clinical decision support tool and evaluating its effect on venous thromboembolism prophylaxis prescribing at a Sydney tertiary teaching hospital
Author(s) -
Soo Garry C.,
Wong Doo Nicole C.,
Burrows Judith,
Ritchie Angus,
Zhang Jan,
Burke Rosemary
Publication year - 2019
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/jppr.1562
Subject(s) - medicine , audit , venous thromboembolism , usability , risk assessment , clinical decision support system , intensive care medicine , electronic medical record , emergency medicine , decision support system , thrombosis , computer security , management , human–computer interaction , artificial intelligence , computer science , economics
Background An electronic venous thromboembolism ( VTE ) prophylaxis clinical decision support ( CDS ) tool was implemented in an electronic medication management system at an Australian tertiary teaching hospital. The VTE CDS had not been clinically validated nor widely adopted. Aim This study evaluated the effectiveness of the VTE CDS for improving risk‐appropriate prescribing of VTE prophylaxis, a peer‐to‐peer strategy for improving adoption of the VTE CDS and the effects of the strategy on VTE risk assessment documentation, risk‐appropriate prophylaxis prescribing rate and user acceptability of the VTE CDS . Methods Nominated junior medical officers were trained to educate and promote the use of the VTE CDS to target colleagues over 6 weeks. Pre‐ and postintervention audits of VTE risk assessment and prophylaxis prescribing were conducted. A user acceptance survey was distributed. Results Analysis of pre‐ and postintervention audit data ( n = 198 for each) revealed no significant differences in rates of VTE CDS adoption or risk‐appropriate VTE prophylaxis prescribed. More patients had risk‐appropriate prophylaxis prescribed when the VTE CDS was used (90%; 63/70) than when it was not used (71.5% (233/326); p = 0.001). Documented evidence of VTE risk assessment increased significantly from 51.5% (102/198) to 68.2% (135/198) following the intervention (p < 0.001). Most survey responses were favourable towards VTE CDS usability despite limitations. Conclusion Peer‐to‐peer promotion was unsuccessful in improving VTE CDS adoption in this study. Findings suggest VTE CDS use is associated with more appropriate VTE prophylaxis prescribing decisions and may improve risk assessment documentation. Future studies should examine strategies to sustainably improve adoption of VTE CDS and patient outcomes.