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Publication
Clinical Decision Support Systems for Pressure Ulcer Management: Systematic Review
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Advisor(s)
Abstract(s)
Background: The clinical decision-making process in pressure ulcer management is complex, and its quality depends on both
the nurse's experience and the availability of scientific knowledge. This process should follow evidence-based practices incorporating
health information technologies to assist health care professionals, such as the use of clinical decision support systems. These
systems, in addition to increasing the quality of care provided, can reduce errors and costs in health care. However, the widespread
use of clinical decision support systems still has limited evidence, indicating the need to identify and evaluate its effects on nursing
clinical practice.
Objective: The goal of the review was to identify the effects of nurses using clinical decision support systems on clinical decision
making for pressure ulcer management.
Methods: The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews
and Meta-Analyses) recommendations. The search was conducted in April 2019 on 5 electronic databases: MEDLINE, SCOPUS,
Web of Science, Cochrane, and CINAHL, without publication date or study design restrictions. Articles that addressed the use
of computerized clinical decision support systems in pressure ulcer care applied in clinical practice were included. The reference
lists of eligible articles were searched manually. The Mixed Methods Appraisal Tool was used to assess the methodological
quality of the studies.
Results: The search strategy resulted in 998 articles, 16 of which were included. The year of publication ranged from 1995 to
2017, with 45% of studies conducted in the United States. Most addressed the use of clinical decision support systems by nurses
in pressure ulcers prevention in inpatient units. All studies described knowledge-based systems that assessed the effects on clinical
decision making, clinical effects secondary to clinical decision support system use, or factors that influenced the use or intention
to use clinical decision support systems by health professionals and the success of their implementation in nursing practice.
Conclusions: The evidence in the available literature about the effects of clinical decision support systems (used by nurses) on
decision making for pressure ulcer prevention and treatment is still insufficient. No significant effects were found on nurses'
knowledge following the integration of clinical decision support systems into the workflow, with assessments made for a brief
period of up to 6 months. Clinical effects, such as outcomes in the incidence and prevalence of pressure ulcers, remain limited
in the studies, and most found clinically but nonstatistically significant results in decreasing pressure ulcers. It is necessary to
carry out studies that prioritize better adoption and interaction of nurses with clinical decision support systems, as well as studies
with a representative sample of health care professionals, randomized study designs, and application of assessment instruments
appropriate to the professional and institutional profile. In addition, long-term follow-up is necessary to assess the effects of
clinical decision support systems that can demonstrate a more real, measurable, and significant effect on clinical decision making.
Description
Keywords
Pressure ulcer Decision support systems
Citation
JMIR Med Inform 2020 | vol. 8 | iss. 10 | e21621
Publisher
Christian Lovis