Cognitive Support Informatics for Nurse Medication Stewardship

描述（由申请人提供）： 摘要护士在药物管理中扮演着重要的角色，他们负责药物管理、审查医嘱、监测治疗效果和不良反应。加强循证实践和患者安全是护理服务（ONS）的VA办公室的优先事项。最常见的药物不良事件（ADE）之一是精神状态的急性变化，包括谵妄、嗜睡和精神病。在住院的老年人中，急性精神状态变化可能高达25%。监测精神状态的变化，采取预防措施和减轻伤害需要临床角色之间的有效协调。 谵妄可能影响估计14-56%的所有住院老年患者。由于其波动性，谵妄特别难以检测，需要加强监测和全面记录。未确诊的谵妄在普通病房高达32- 67%，在急诊病房为65%，在疗养院低至86%。 在一篇综述中，护士对谵妄症状的认识从26%到83%不等。缺乏对护士和综合团队方法的认知支持。 项目目标AIM 1：描述护士的药物管理信息需求，文件和沟通过程与识别和监测急性精神状态变化（AMSC）在住院设置。 目标2：创建一个预测模型，将AMSC预测因子和AMSC文本描述符与人员配置数据相集成，以支持治疗决策，资源规划和协作AIM 3：设计和测试三种认知支持干预措施：1）通过BCMA为护士提供信息按钮决策支持（条形码药物给药）; 2）嵌入在白色板显示器中的警报; 3）显示来自叙述性电子笔记的记录的精神状态变化。 目标4：在两个先锋站点实施和评估AMSC综合计划的影响。该计划将侧重于：1）护理监测和文件的质量，2）护士和医生之间的沟通质量，3）谵妄率，以及4）医生处方模式的适当性。 项目方法目标1包括观察，访谈和电话调查的护士，护士长，医生和药剂师以及图表审查，以确定药物管理信息的需求。 目标2涉及开发本体论，自然语言处理方法和国家数据的风险模型，将谵妄风险与药物和人员决策联系起来。 目标3包括设计和可用性测试。 目标4将是一项可行性执行研究，评估干预措施对两个地点和四个医疗/外科单位的影响。

DESCRIPTION (provided by applicant): ABSTRACT Anticipated Impacts on Veteran's Health Care Nurses play a critical role in medication management through their responsibilities for medication administration, reviewing orders, and monitoring for therapeutic effectiveness and adverse effects. Enhancing evidence-based practice and patient safety is a priority of the VA Office of Nursing Service (ONS). One of the most common adverse drug events (ADE) is an acute change in mental status, including delirium, somnolence and psychosis. In older hospitalized adults, acute mental status changes can be as high as 25%. Monitoring for changes in mental status, initiating preventative actions and mitigating harm requires effective coordination between clinical roles. Project Background Delirium may impact an estimated 14-56% of all hospitalized elderly patients. Because of its fluctuating nature, delirium is particularly difficult to detect and requires increased monitoring and comprehensive documentation. Undiagnosed delirium has been cited to be as high as 32- 67% on general medical wards, 65% in emergency wards and as low as 86% in nursing homes. In one review, nurses' recognition of delirium symptoms ranged from 26% to 83%. Cognitive support for nurses and for an integrated team approach is lacking. Project Objectives AIM 1: Characterize nurses' medication management information needs, documentation and communication processes associated with identifying and monitoring acute mental status changes (AMSC) in inpatient settings. AIM 2: Create a predictive model that integrates AMSC predictors and text descriptors of AMSC with staffing data, to support therapeutic decision-making, resource planning and collaboration AIM 3: Design and test three cognitive support interventions: 1) Info-button decision-support for nurses provided through BCMA (bar-coded medication administration); 2) alerts imbedded in white board display; 3) display of documented mental status changes from the narrative electronic notes. AIM 4: Implement and assess the impact of a comprehensive program for AMSC at two vanguard sites. This program will focus on the: 1) quality of nursing monitoring and documentation, 2) quality of communication between nurses and physicians, 3) rates of delirium, and 4) appropriateness of physician prescribing patterns. Project Methods Aim 1 involves observation, interviews and phone surveys of nurses, charge nurses, physicians and pharmacist as well as chart review to identify medication management information needs. Aim 2 involves developing an ontology, natural language processing methods and a risk model from national data to link risk for delirium with medication and staffing decision-making. Aim 3 consists of design and usability testing. Aim 4 will be a feasibility implementation study assessing the impact of the interventions on two sites and four medical/surgical units.