Using 'nudge' principles for order set design: a before and after evaluation of an electronic prescribing template in critical care
Using 'nudge' principles for order set design: a before and after evaluation of an electronic prescribing template in critical care
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DOI：
10.1136/bmjqs-2013-002395
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发表时间：
2014-05-01
影响因子：
5.4
通讯作者：
Gould, Timothy H.
中科院分区：
文献类型：
--
作者：
Bourdeaux, Christopher P.;Davies, Keith J.;Gould, Timothy H.
目的计算机医嘱集具有减少临床变异和提高患者安全性的潜力，但效果是可变的。我们试图评估的影响，改变的顺序设置的氯己定漱口水和羟乙基淀粉（羟乙基淀粉）的患者在重症监护室的交付设计。方法这项研究是在大学医院布里斯托NHS信托基金会，英国。我们的重症监护室使用临床信息系统（CIS）。所有的药物和液体都与CIS一起开处方，药物和液体图表存储在数据库中。2010年1月，将氯己定漱口水作为默认处方添加到处方模板中。2009年4月，从处方模板中删除了羟乙基淀粉。在整个研究期间，两种干预措施均可手动处方。我们进行了一个数据库的审查，所有患者有资格为每个干预之前和之后的变化，配置的选择在prescribingsystem.Results内的2231通气患者被确定为适当的治疗与洗必泰，591干预前和1640后。改变前55.3%的人开了氯己定，改变后90.4%（p
Objective Computerised order sets have the potential to reduce clinical variation and improve patient safety but the effect is variable. We sought to evaluate the impact of changes to the design of an order set on the delivery of chlorhexidine mouthwash and hydroxyethyl starch (HES) to patients in the intensive care unit.Methods The study was conducted at University Hospitals Bristol NHS Foundation Trust, UK. Our intensive care unit uses a clinical information system (CIS). All drugs and fluids are prescribed with the CIS and drug and fluid charts are stored within a database. Chlorhexidine mouthwash was added as a default prescription to the prescribing template in January 2010. HES was removed from the prescribing template in April 2009. Both interventions were available to prescribe manually throughout the study period. We conducted a database review of all patients eligible for each intervention before and after changes to the configuration of choices within the prescribing system.Results 2231 ventilated patients were identified as appropriate for treatment with chlorhexidine, 591 before the intervention and 1640 after. 55.3% were prescribed chlorhexidine before the change and 90.4% after (p