Analysis of nursing clinical decision support requests and strategic plan in a large academic health system

Abstract

Objectives: To understand requests for nursing Clinical Decision Support (CDS) interventions at alarge integrated health system undergoing vendor-based EHR implementation. In addition, to establisha process to guide both short-term implementation and long-term strategic goals to meetnursing CDS needs. Materials and Methods: We conducted an environmental scan to understand current state ofnursing CDS over three months. The environmental scan consisted of a literature review and ananalysis of CDS requests received from across our health system. We identified existing high priorityCDS and paper-based tools used in nursing practice at our health system that guide decision-making. Results: A total of 46 nursing CDS requests were received. Fifty-six percent (n=26) were specific toa clinical specialty; 22 percent (n=10) were focused on facilitating clinical consults in the inpatientsetting. “Risk Assessments/Risk Reduction/Promotion of Healthy Habits” (n=23) was the most requestedHigh Priority Category received for nursing CDS. A continuum of types of nursing CDSneeds emerged using the Data-Information-Knowledge-Wisdom Conceptual Framework: 1) facilitatingdata capture, 2) meeting information needs, 3) guiding knowledge-based decision making,and 4) exposing analytics for wisdom-based clinical interpretation by the nurse. Conclusion: Identifying and prioritizing paper-based tools that can be modified into electronic CDSis a challenge. CDS strategy is an evolving process that relies on close collaboration and engagementwith clinical sites for short-term implementation and should be incorporated into a long-termstrategic plan that can be optimized and achieved overtime. The Data-Information-Knowledge-WisdomConceptual Framework in conjunction with the High Priority Categories established may be auseful tool to guide a strategic approach for meeting short-term nursing CDS needs and aligningwith the organizational strategic plan.