Informatics and Quality Improvement
Clinical Decision Support Tools
Clinical decision support (CDS) encompasses a variety of technological tools that directly support
clinical decisions across settings. Which of the following are an examples of CDS? Select all that apply.
Real-time monitors and dashboards
Automatic order implementation
Event-driven alerts and reminders
Condition-specific guidelines, order sets, care plans, and protocols
Smart documentation forms and templates
CDS encompasses a variety of technological tools that directly support clinical decisions across settings
including:
Immediate warning alerts for clients and providers
Event-driven alerts and reminders
Parameter guidance for providers
Real-time monitors and dashboards
Condition-specific guidelines, order sets, care plans, and protocols
Smart documentation forms and templates
CDS architectures that influence design, implementation, and adoption
It provides order implementation support for a provider but not the automatic initiation of orders.
Automated Medication Dispensing System
The nurse retrieves medication through an automated medication dispensing system. How does an
automated medication dispensing system increase the quality of care?
Eliminates client misidentification
Reduces intravenous (IV) pump programming errors
Eliminates adverse drug reactions
Decreases medication errors
The use of an automated medication dispensing system decreases medication errors. It does not
eliminate adverse drug reactions or identification errors, since providers still need to go through the
medication administration checks at the bedside. It also does not reduce IV pump programming errors.
This alert would be part of a smart pump.
Culture of Safety
,How does technology promote a culture of safety?
Electronic incident reports improve reporting rates
Clinical decision support systems determine consequences
Video surveillance catches perpetrators
Databases track who has been involved in unsafe acts
A culture of safety is where all employees are committed to being safe, whether or not someone is
watching. It is not about punishing unsafe acts or catching perpetrators. Technology can be used to
improve reporting rates of incidents, allowing organizations to identify issues and respond with solutions
to improve quality and safety.
Types of Clinical Decision Support
The nurse scans bar codes of the client’s wristband and the medication. An alert comes up on the
computer of a potential drug-allergy interaction. This is an example of which type of clinical decision
support?
Expert Systems
Point-of-Care
Workflow Support
Order Implementation
Point-of-Care alerts include drug-condition interaction reminders , drug-drug interaction , drug-allergy
interactions , plan-of-care alerts , and high-risk state monitoring .
Order implementation assists providers with order sets and protocols. Expert systems offer support for
labs, equipment, and tools. Workflow support provides templates and documentation support.
Smart Pumps
The nurse is using a smart pump in the emergency room. How does a smart pump increase the quality
of care?
Decreases adverse drug reactions
Eliminates client misidentification
Reduces programming errors
Eliminates medication errors
The use of smart pumps reduces programming errors. It does not eliminate medication or identification
errors, since providers still need to go through the medication administration checks. It also does not
decrease adverse drug reactions. This alert would be part of medication administration.
Alert Fatigue
, One study in an intensive care unit found that they had 187 alarms per bed per day, of which 72%-99%
were false alarms (Drew et al., 2014). How could this unit use technology to combat alert fatigue?
Changing the default alarm settings to settings based on each client’s condition
Install flashing colors that correspond to each of the types of alarms
Hire more staff to attend to the alarms
Increase the decibels on all alarms from 70 dB to 90 dB
Since all client’s are unique, tailoring alarm signals of devices to each client’s needs can reduce the
number of false alarms and therefore, reducing the total number of alarms. Increasing the decibels or
using flashing colors will cause more sensory overload. Hiring more staff is expensive and does not
combat the alert fatigue.
Reference
Drew, B. J., Harris, P., Zègre-Hemsey, J. K., Mammone, T., Schindler, D., Salas-Boni, R., Bai, Y., Tinoco, A.,
Ding, Q., & Hu, X. (2014). Insights into the problem of alarm fatigue with physiologic monitor devices: a
comprehensive observational study of consecutive intensive care unit patients. Plos One, 9(10),
e110274. https://doi.org/10.1371/journal.pone.0110274
Sentinel Events
Which of these sentinel events, or “never events,” could technology prevent?
Staff injury associated with a burn
Staff death or serious disability associated with an electric shock
Surgery or other invasive procedure performed on the wrong client
Significant injury of a staff member resulting from a physical assault
Identification errors can be prevented using a bar code system or other technology coded system where
the procedure or medication is “matched” with the correct client. It is difficult for current technology to
prevent spontaneous accidents or situations.
Electronic Incident Reporting
A local clinic had a low rate of reported safety issues. After instituting an electronic incident reporting
form, the rates went up. What is the most likely reason for the increase in incident reports?
It was easier for staff to access and fill out forms.
The clinical staff were more careless.
The clinical staff did not understand the reporting process.
It was more difficult to access safety information.
Studies have shown that organizations that moved to an electronic reporting system have an increased
rate of reporting frequency. It does not mean the staff were more careless. It means that reporting was
Clinical Decision Support Tools
Clinical decision support (CDS) encompasses a variety of technological tools that directly support
clinical decisions across settings. Which of the following are an examples of CDS? Select all that apply.
Real-time monitors and dashboards
Automatic order implementation
Event-driven alerts and reminders
Condition-specific guidelines, order sets, care plans, and protocols
Smart documentation forms and templates
CDS encompasses a variety of technological tools that directly support clinical decisions across settings
including:
Immediate warning alerts for clients and providers
Event-driven alerts and reminders
Parameter guidance for providers
Real-time monitors and dashboards
Condition-specific guidelines, order sets, care plans, and protocols
Smart documentation forms and templates
CDS architectures that influence design, implementation, and adoption
It provides order implementation support for a provider but not the automatic initiation of orders.
Automated Medication Dispensing System
The nurse retrieves medication through an automated medication dispensing system. How does an
automated medication dispensing system increase the quality of care?
Eliminates client misidentification
Reduces intravenous (IV) pump programming errors
Eliminates adverse drug reactions
Decreases medication errors
The use of an automated medication dispensing system decreases medication errors. It does not
eliminate adverse drug reactions or identification errors, since providers still need to go through the
medication administration checks at the bedside. It also does not reduce IV pump programming errors.
This alert would be part of a smart pump.
Culture of Safety
,How does technology promote a culture of safety?
Electronic incident reports improve reporting rates
Clinical decision support systems determine consequences
Video surveillance catches perpetrators
Databases track who has been involved in unsafe acts
A culture of safety is where all employees are committed to being safe, whether or not someone is
watching. It is not about punishing unsafe acts or catching perpetrators. Technology can be used to
improve reporting rates of incidents, allowing organizations to identify issues and respond with solutions
to improve quality and safety.
Types of Clinical Decision Support
The nurse scans bar codes of the client’s wristband and the medication. An alert comes up on the
computer of a potential drug-allergy interaction. This is an example of which type of clinical decision
support?
Expert Systems
Point-of-Care
Workflow Support
Order Implementation
Point-of-Care alerts include drug-condition interaction reminders , drug-drug interaction , drug-allergy
interactions , plan-of-care alerts , and high-risk state monitoring .
Order implementation assists providers with order sets and protocols. Expert systems offer support for
labs, equipment, and tools. Workflow support provides templates and documentation support.
Smart Pumps
The nurse is using a smart pump in the emergency room. How does a smart pump increase the quality
of care?
Decreases adverse drug reactions
Eliminates client misidentification
Reduces programming errors
Eliminates medication errors
The use of smart pumps reduces programming errors. It does not eliminate medication or identification
errors, since providers still need to go through the medication administration checks. It also does not
decrease adverse drug reactions. This alert would be part of medication administration.
Alert Fatigue
, One study in an intensive care unit found that they had 187 alarms per bed per day, of which 72%-99%
were false alarms (Drew et al., 2014). How could this unit use technology to combat alert fatigue?
Changing the default alarm settings to settings based on each client’s condition
Install flashing colors that correspond to each of the types of alarms
Hire more staff to attend to the alarms
Increase the decibels on all alarms from 70 dB to 90 dB
Since all client’s are unique, tailoring alarm signals of devices to each client’s needs can reduce the
number of false alarms and therefore, reducing the total number of alarms. Increasing the decibels or
using flashing colors will cause more sensory overload. Hiring more staff is expensive and does not
combat the alert fatigue.
Reference
Drew, B. J., Harris, P., Zègre-Hemsey, J. K., Mammone, T., Schindler, D., Salas-Boni, R., Bai, Y., Tinoco, A.,
Ding, Q., & Hu, X. (2014). Insights into the problem of alarm fatigue with physiologic monitor devices: a
comprehensive observational study of consecutive intensive care unit patients. Plos One, 9(10),
e110274. https://doi.org/10.1371/journal.pone.0110274
Sentinel Events
Which of these sentinel events, or “never events,” could technology prevent?
Staff injury associated with a burn
Staff death or serious disability associated with an electric shock
Surgery or other invasive procedure performed on the wrong client
Significant injury of a staff member resulting from a physical assault
Identification errors can be prevented using a bar code system or other technology coded system where
the procedure or medication is “matched” with the correct client. It is difficult for current technology to
prevent spontaneous accidents or situations.
Electronic Incident Reporting
A local clinic had a low rate of reported safety issues. After instituting an electronic incident reporting
form, the rates went up. What is the most likely reason for the increase in incident reports?
It was easier for staff to access and fill out forms.
The clinical staff were more careless.
The clinical staff did not understand the reporting process.
It was more difficult to access safety information.
Studies have shown that organizations that moved to an electronic reporting system have an increased
rate of reporting frequency. It does not mean the staff were more careless. It means that reporting was
