NR 599 Week 5: Clinical Decision Support Systems

NR 599 Week 5: Clinical Decision Support Systems

NR 599 Week 5: Clinical Decision Support Systems

Discussion 

Purpose 

The ideas and beliefs underpinning the discussions guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship. 

Course Outcomes 

This assignment enables the student to meet the following course outcomes: 

  • Contribute level-appropriate knowledge and experience to the topic in a discussion environment that models professional and social interaction (CO4) 
  • Actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty (CO5) 

Due Date 

Students must post a minimum of 3 times in each graded discussion. The 3 posts in each individual discussion must be on separate days. Posting 3 times on 3 different days meets the minimum requirement for full credit; each post must be substantive. The student must provide an initial post to each graded discussion topic posted by the course instructor, by Wednesday, 11:59 p.m. MT of Week 5. Subsequent posts, including essential responses to peers, must occur no later than the Sunday, 11:59 p.m. MT at the end of Week 5. Students are expected to submit assignments by the time they are due. Threaded discussions are not considered assignments and are not part of the late assignment policy. 

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). 

Total Points Possible: 150 

Preparing the Assignment 

Post a written response in the discussion forum to EACH threaded discussion topic: 

  1. This week we learned about the potential benefits and drawbacks to clinical decision support systems (CDSSs). Create a “Pros” versus “Cons” table with a column for “Pro” and a separate column for “Con”. Include at least 3 items for each column. Next to each item, provide a brief rationale as to why you included it on the respective list. 

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  1. 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!  

Adhere to the following guidelines regarding quality for the threaded discussions in Canvas: 

  • Application of Course Knowledge: Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings. 
  • Scholarliness and Scholarly Sources: Demonstrates achievement of scholarly inquiry for professional and academic decisions using valid, relevant, and reliable outside scholarly source to contribute to the discussion thread.  
  • Writing Mechanics: Grammar, spelling, syntax, and punctuation are accurate. In-text and reference citations should be formatted using correct APA guidelines. 
  • Direct Quotes: Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.  

For each threaded discussion per week, the student will select no less than TWO scholarly sources to support the initial discussion post. 

Scholarly Sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal.NR 599 Week 5: Clinical Decision Support Systems

 You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article.  The following sources should not be used: Wikipedia, Wikis, or blogs.  These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality.  For example, the American Heart Association is a .com site with scholarship and quality.  It is the responsibility of the student to determine the scholarship and quality of any .com site.  Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years.  Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years. 

DISCUSSION CONTENT 
Category  Points  %  Description 
Application of Course Knowledge 

 

50  33%  The quality for this category is determined by the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lessons and outside readings and relate them to real-life professional situations. 
Scholarliness and Scholarly Resources 

 

40  27%  This category is evaluated on the quality of the student’s ability to: Support writing with appropriate, scholarly sources; provide relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions; evaluate literature resources to develop a comprehensive analysis or synthesis; use sources published within the last 5 years; match reference list and in-text citations match, and minimize or appropriately format direct quotations. 

 

Interactive Dialogue  40  27%  The quality for this category is determined by substantive written responses to a peer and faculty member’s questions in the threaded discussion. Substantive posts add importance, depth, and meaningfulness to the discussion. Students must respond to least one peer in the threaded discussion. If no question asked directly from faculty, student must respond to questions posed to the entire class. Post must include at least one scholarly source. 

 

      Total CONTENT Points = 130 
DISCUSSION FORMAT 
Category  Points  %  Description 
Grammar, Spelling, Syntax, Mechanics and APA Format  20  13% 

 

Reflection post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post. 

* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included. 

**Direct quote should not to exceed 15 words & must add substantively to the discussion 

      Total FORMAT Points = 20 
      DISCUSSION TOTAL = 150 Points 

**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.

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:  NR 599 Week 5: Clinical Decision Support Systems

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). NR 599 Week 5: Clinical Decision Support Systems

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.

I truly enjoyed reading through your post. The use of CDSS helps the clinician to make the best clinical decision in order to provide the best option for care.  According the study done by Shi (2023) it was discovered that the use of CDSS in the management of patients with  diabetes proved very effective as it helps the provider  determine patients who are mostly at risk for