Clinical Decision Support

A state of irritability, exhaustion, or confusion triggered in clinicians who have been exposed to too many alerts which ca spend the exploiter to ignore some or all the alerts. Ameri can National Standards name (ANSI) coordinates for the increment of health bevel Sevens Arden Syntax Standard. Bar ordinance medical exam specialty Administration (ABACA) An in affected role CADS to assist nurses with the quintette rights of practice of medicine formation. Provides warnings if any of the five rights be violated. It also requires the nurses to enter an override reason if he/she chooses to proceed.Bar Code Medication Administration Health Level Seven (HAL) A standards development organization for health education technology (HIT) Look-Alike, Sound-Alike (ALAS) Drugs with standardized spelling or pronunciation. Refers to providing clinicians or patients with clinical knowledge and patient-related information, intelligently filtered or presented to appropriate times, to promote patient deal out. Integrate patient-specific data with an available knowledge base in order to assist the clinician in selecting and delivering the safest and virtually effective therapies.Clinical purpose swear System A system intended to provide CDC to clinicians, deal outgivers and health alimony consumers. An change CADS includes 1. A Knowledge base 2. An Event monitor 3. A Communication system Take Note CADS may be a stand alone system CADS may be integrated into different technology solutions (ex. Bar code scanning technology and e-Prescribing) General Attri thoes of CADS 1. knowing for three purposes Improve the quality of clinical decisions Notify of say-so dislodge in patient status . Prevent errant action at the point of care a.Error of commission b. Error of omission 2. Patient specificity 3. scope sensitive- relates directly to the work at hand 4. Integrated into workflow- convenient to use. 5. Timely- executes in real time 6. Pushes informati on to the clinician, care-giver or health care consumer 7. intelligently filtered clinical information Information, advice or warning is relevant and meaningful CADS uses patient data to infer that the message is actually needed. CADS is customizable to clinical preferences. Types of Clinical Decision Support A. Patient-specific CADS B.Non-patient specific CADS This type of CADS consist of three types f alerts 1 . Commercial medicine-interaction alerting system 2. Commercial dose and dose-range checking alerts 3. Commercial clinical rules engine Commercial drug-interaction alerting system Most common in COPE and Pharmacy Information systems. Provides alerts for drug-allergy, drug-drug, drug-pregnancy and other interactions. Limitation is that severity levels Of drug interaction is pre-assigned by the vendor based on the anticipated unfavorable reaction and cannot be customized.Four Possible Results from deterioration alerting system bouncy Result Produces alert? Relevant? Clinician deeds to see? True compulsive Yes True Negative NO No Positive False Yes but never gets the chance Commercial dose and dose-range checking alerts Currently, this is rudimentary using fewer patient data, usually only age. Therefore this systems only loosely start paternalistic category. Commercial clinical rules engine These allow local development or customization of clinical content and programming logic. 2. 3. 4.Data mining Informational notice state sets Knowledge retrieval systems Provides population specific relationships and information. Encompasses numerous methods used to tell apart patterns and relationships in data. Usually just-in-time, product specific information. Examples 1 . Provides alert for assertable ALAS 2. In COPE, it might be order specific information much(prenominal) as the cost off lab test, or conventionality status of a drug. An organized set of patient care orders that are usually population, procedure or disease specific. It may be evidence-based such as clinical guideline. The KIRKS It could be 1. Primary KIRKS ex. Google and 2. Secondary KIRKS (Harridans online) 3. Tertiary KIRKS (ASAP, Thomson Health care and How to maximize the benefits Of CADS? Maximizing the benefits 1. Ensure that the data available for decision-making is as comprehensive as possible. Data should be current and urge Larry updated. 2. perfect the method by which the decision support information is delivered to the health care provider values of CADS Application of CADS in different current medical technologies available 1.COPE 2. OMAR(Getronics Medication Administration 3. flip Pumps 4. Automated distribution cabinets CADS in COPE CADS integrated in COPE can Reduce medicinal drug errors (any preventable event that may lead to inappropriate medication use or cause harm to he patient while the medication is in the control of a health care professional, patient or consumer) Improve compliance with recommended monitoring or adjun ctive therapies. Improve efficacy by reducing the time spent clarifying incomplete orders. disguise for a variety or take chancess on the point of entry (ex. echo therapy, drug-drug, allergic cross sensitivities) can reduced mathematical errors by automating weight-based and similar dosing calculations. can identify possible ALAS medications. Computerized Provider Order intromission CADS in Omar OMAR (Electronic Medication Administration Record) CADS integrated in Omar can shadower provide real time confirmation of the 5 rights of medication administration 1. safe medication 2. Right dose 3. Right route 4. Right patient 5.Right time Can screen for recent changes in testing ground parameters, vital signs, or allergy status which may interact with a scheduled medication and alert the nurse prior to administration. Ex laboratory shows critical level of potassium thereby alerting the nurse out front administering dioxin to patient. CADS in Smart Pumps Smart pump- a com puterized infusion device that can be programmed to include specific set of data. CADS integrated in Smart Pumps can Provide real time confirmation of the volume, rate and compactness of the solution being administered.Smart Pumps CADS in Automated Dispensing Cabinets ADS- secure storage cabinets typically located decennially on patient care units capable of handling most unit-dose and multiple dose medications. CADS integrated in ADS can Notify nurses of potential hypersensitivity or ADAIR when certain trigger medications are withdrawn for a patient. In pharmacy, can provide alerts when medication is withdrawn too early or too ate based on scheduled administration time. Automated Dispensing Cabinets Unintended consequences in CADS A. Alert fatigue 8. Delay in care C. System coifance A.Alert fatigue Tendency users to become overwhelmed and begin to ignore CDC messages due to a high quantity of alerts or a wisdom that the alerts have little perceived value. B. Delay in ca re The risk that interruptions in the workflow caused by clinical decision support alerts or system limitations may lead to a delay in bringing of patient care. C. System Performance The risk that the processor resources seed by the CADS will cause the hospital information system software to perform slowly. Arden syntax standard A programming language designed for clinicians to get to clinical rules. Streamlined computer language based on Pascal. true in Columbia University Arden Homestead in 1989. This standard provides a method to construct clinical rules, such as alerts, reminders and tributes, known as Ml. Provides a flexible and clinically way to develop Ml. What is Ml? Ml nitty-gritty Medical Logical Modules Offers a suggestion or warning (alert, recommendation or reminder) regarding a alnico decision or action, or an informational notice to get over a change in a patients clinical status.