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首页> 外文期刊>JMIR Medical Informatics >Clinical Decision Support Systems for Pressure Ulcer Management: Systematic Review
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Clinical Decision Support Systems for Pressure Ulcer Management: Systematic Review

机译：压力溃疡管理临床决策支持系统：系统评价

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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.
机译：背景技术压力溃疡管理中的临床决策过程是复杂的，其质量取决于护士的经验和科学知识的可用性。该过程应遵循基于证据的实践，纳入健康信息技术以协助医疗保健专业人员，例如使用临床决策支持系统。除了增加所提供的护理质量外，这些系统可以减少医疗保健中的错误和成本。然而，临床决策支持系统的广泛使用仍然存在有限的证据，表明需要识别和评估其对护理临床实践的影响。目的审查的目标是确定护士对临床决策支持系统对压力溃疡管理的临床决策影响。方法根据PRISMA进行系统审查（首选的系统评价和荟萃分析）建议进行。搜索是在2019年4月进行的5个电子数据库进行：Medline，Scopus，科学，Cochrane和Cinahl，没有出版日期或学习设计限制。包括在临床实践中使用的压力溃疡护理中使用计算机化临床决策支持系统的文章。手动搜索符合条件的文章的参考列表。混合方法评估工具用于评估研究的方法论质量。结果搜索策略导致998篇文章，其中16条包括在内。出版年度从1995年到2017年，在美国进行了45％的研究。大多数人都通过护士进行了临床决策支持系统，在住院部门预防的压力溃疡。所有研究都描述了基于知识的系统，评估了对临床决策的影响，继发于临床决策支持系统使用的临床效果，或影响使用卫生专业人员使用临床决策支持系统的使用或意图的因素以及其实施的成功护理练习。结论可用文学中的证据是关于临床决策支持系统（护士使用）对压力溃疡预防和治疗决策的影响仍然不足。在将临床决策支持系统集成到工作流程中，在护士的知识中没有发现任何显着影响，评估长达6个月。临床效果，如溃疡发病率和患病率的结果，在研究中仍然有限，并且在临床上发现临床但不具有临床显着的显着导致压力溃疡降低。有必要进行研究，优先考虑护士采用和临床决策支持系统的更好采用和相互作用，以及与适合专业和体制外形适用于专业和体制外形的评估工具的研究。此外，需要长期随访，以评估临床决策支持系统的影响，这些临床决策支持系统可以证明对临床决策的更真实，可测量和显着影响。

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