NR 599 Week 5 Discussion: Clinical Decision Support Systems (CDSSs)

NR 599 Week 5 Discussion: Clinical Decision Support Systems (CDSSs)

NR 599 Week 5 Discussion: Clinical Decision Support Systems (CDSSs)

Potential Benefits and Drawbacks to Clinical Decision Support Systems

Pros	Cons
Improves healthcare providers’ decision-making processes in complex patient cases.The CDSS enhances healthcare delivery by facilitating clinical decision-making with targeted clinical knowledge, patient data, and other health information (Muhiyaddin et al., 2020).	The CDSS is seen as a threat by primary care providers to their clinical autonomy.Clinicians are the users of the CDSS.Some perceive that the purpose of the system is to limit their autonomy, which leads to reluctance to use the CDSS or use it inappropriately (Muhiyaddin et al., 2020).
Improves delivery of evidenced-based care by healthcare providers.The CDSS analyzes data within electronic health records (EHRs) and gives prompts and reminders to help health providers implement evidence-based clinical guidelines during patient care (Sutton et al., 2020).	The CDSS can be very costly to adopt, maintain, and support.The CDSS requires high costs for technical maintenance of systems applications and databases that power the CDSS and continuous staff training (Sutton et al., 2020).
Increases patient safety and reduces the rate of misdiagnosis.The CDSS has alerts that notify clinicians of potential adverse drug events that may occur with drugs prescribed to a patient, which reduces the incidences of adverse drug reactions (Muhiyaddin et al., 2020). It also has computerized clinical guidelines and diagnostic support that assist clinicians in making clinical diagnoses.	CDSS is associated with alert fatigue and inappropriate alerts.The CDSS often give inconsequential alerts that physicians tend to disagree with or distrust (Muhiyaddin et al., 2020). The inappropriate alerts are linked with alert fatigue for clinicians.

Clinical Patient and Scenario

An 8-year-old boy is brought to the ED with difficulties in breathing, wheezing, and a history of cough. The ED physician suspects the child has asthma and performs a spirometry test which reveals a forced expiratory volume (FEV1) of 70%. The physician administers the child Albuterol and then performs a spirometry test again, which improves to 85%. The FEV1 results are recorded in the CDSS-integrated EHR, which suggests that the patient has Asthma. In addition, the CDSS suggests the physician prescribe a Short-acting beta-agonist since it is the recommended evidence-based treatment for asthma for this patient. After one week, the patient returns to the ED with complaints of worsening dyspnea and wheezing despite using an Albuterol inhaler daily. The CDSS will suggest stepping up treatment to a low-dose inhaled corticosteroid such as Beclomethasone. Evidence-based guidelines suggest that if a Short-acting beta-agonist is used for more than two days per week except during exercise, it is considered inadequate control.

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NR 599 Week 5 Discussion: Clinical Decision Support Systems (CDSSs) References

Muhiyaddin, R., Abd-Alrazaq, A. A., Househ, M., Alam, T., & Shah, Z. (2020). The Impact of Clinical Decision Support Systems (CDSS) on Physicians: A Scoping Review. Studies in health technology and informatics, pp. 272, 470–473. https://doi.org/10.3233/SHTI200597

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ digital medicine, 3(1), 17. https://doi.org/10.1038/s41746-020-0221-y

Pros of CDSS	Cons of CDSS
1 The use of CDSS increases patient safety: CDSS is a computer-based that sifts through tons of Data in real time to provide the health care provider with the most accurate and practical options for treatment. This system uses Data to prevent polypharmacy and possible drug-to-drug interaction, side effects, or practical, safe drug combinations.	1: CDSS can compromise clinician judgment: CDSS is based on data and evidence based on the data imputed in the system. For a provider to effectively provide care, there must be a relationship between Evidenced bas and clinician judgment. The CDSS system sometimes makes it tasking for providers to bypass the alarms arising from a provider not agreeing with the CDSS options. It can sometimes be frustrating for providers to bypass alarms or notifications to provide person-centered care.
2CDSS fosters evidence-based practices: The CDSS is programmed to provide clinical information to the provider that relates to evidence-based patient care. This kind of care is effective and ensures compliance by the patient since it is founded on clinical research and evidence. The technology-literate patient will be more compliant with treatment that is an evidence-based clinical decision.	Prescription generation cost: The CDSS can sift through data, make a decision based on evidence from the data and send a prescription to the pharmacy. The prescription can be rejected by either the patient or the insurance due to high cost. This leads to further delay of care and possible non-compliance by the patient
3 CDSS reduces workload and clinician burnout: The use of CDSS is a time and effort saver because the system can discern data in real-time and present interventions or possible treatment suggestions quickly. This helps the provider do more quickly, with less effort, more efficiently, and with less tasking practice.	3; CDSS can cause alarm fatigue in healthcare providers: The system generates an alarm to alert the Provider of any perceived misjudgment or decision that does not tally with the suggestions of the CDSS system. The Provider has the right to use clinical judgment when providing care to the patient. The CDSS system lacks that ability which can cause the generation of alarms.

The primary goal of a CDSS is to leverage data and the scientific evidence to help guide appropriate decision making. CDSSs directly assist the clinician in making decisions about specific patients. For this discussion thread post, you are to assume your future role as an APN and create a clinical patient and scenario to illustrate an exemplary depiction of how a CDSS might influence your decision. This post is an opportunity for you to be innovative, so have fun! 

This morning Mrs. Johnson came into the clinic complaining of pain levels of 8 out of 10 in her legs and arms. The APN performed the physical assessment and ordered some scans to be done on her. During the assessment, Mrs. Johnson did not seem in as much pain as she was verbalizing, and no systemic issues were noted; the APN decided to do a chart check using the CDSS before prescribing pain medications and discovered that Mrs. Johnson has a history for seeking pain meds and suggested other pains relieve measures to assist her. Armed with this information. The APN was able to refer Mrs. Johnson to counseling, a pain management clinic for more specialized care.

Laka, M., Milazzo, A., Carter, D., & Merlin, T. (2021). OP196 Clinical Decision Support Systems (CDSS) For Antibiotic         Management: Factors Limiting Sustainable Digital Transformation. International Journal of Technology Assessment in Health Care, 37(S1), 5–5. https://doi.org/10.1017/S0266462321000763Links to an external site.

Shi, X., He, J., Lin, M., Liu, C., Yan, B., Song, H., Wang, C., Xiao, F., Huang, P., Wang, L., Li, Z., Huang, Y., Zhang, M., Chen, C.-S., Obst, K., Shi, L., Li, W., Yang, S., Yao, G., & Li, X. (2023). Comparative Effectiveness of Team-Based Care With and Without a Clinical Decision Support System for Diabetes Management : A Cluster Randomized Trial. Annals of Internal Medicine, 176(1), 49–58. https://doi.org/10.7326/M22-1950Links to an external site.

Preparing the Assignment

Post a written response in the discussion forum to EACH threaded discussion topic:


	This week we learned about the potential benefits and drawbacks to clinical decision support systems (CDSSs). Create a “Pros” versus “Cons” table with a column for “Pro” and a separate column for “Con”. Include at least 3 items for each column. Next to each item, provide a brief rationale as to why you included it on the respective list.
	The primary goal of a CDSS is to leverage data and the scientific evidence to help guide appropriate decision making. CDSSs directly assist the clinician in making decisions about specific patients. For this discussion thread post, you are to assume your future role as an APN and create a clinical patient and scenario to illustrate an exemplary depiction of how a CDSS might influence your decision. This post is an opportunity for you to be innovative, so have fun! 


Adhere to the following guidelines regarding quality for the threaded discussions in Canvas:


	Application of Course Knowledge: Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings.
	Scholarliness and Scholarly Sources: Demonstrates achievement of scholarly inquiry for professional and academic decisions using valid, relevant, and reliable outside scholarly source to contribute to the discussion thread. 
	Writing Mechanics: Grammar, spelling, syntax, and punctuation are accurate. In-text and reference citations should be formatted using correct APA guidelines.
	Direct Quotes: Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category. 


For each threaded discussion per week, the student will select no less than TWO scholarly sources to support the initial discussion post.