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PROS
- Computerized alerts and reminders for providers and patients
Allergy alerts can prevent medication errors and can be clarified if needed. Patients can benefit from using portals or APPS that have lists of interactions or potential allergies at home. Reminders for providers to administer medication or follow up with a medication response to treatment are beneficial (Keasberry et al, 2017). Patients may use APPs that have reminders set to when they need to take their medication or check their blood pressure, blood sugar or weigh themselves (Yoo et al, 2020).
- Drug-drug interaction alerts
The system will alert providers, pharmacists, and nurses if there is a potential for drug-drug interactions preventing harm to patients. In patients with multiple health problems, and on multiple medications, this is a useful tool to prevent errors and harm (Keasberry et al, 2017).
- Condition-specific order sets
When providers use condition-specific order sets, they tend to adhere to treatment guidelines increasing patient outcomes. Appropriate are noted to be ordered more frequently as well. Clinicians tend to follow guidelines of care more closely, that includes effective disease management, treatment, and appropriate use of medications (Keasberry et al, 2017).
Cons
- Financial impact to organization to implement and maintain
Purchasing, maintaining and training are all costly to organizations and must be considered. Some organizations are hesitant to implement CDSS due to the upfront cost, and cost of maintaining and updating the system, but the benefits of improved care, and prevention of medical errors must be considered (Keasberry, 2017).
In a study of an urban academic hospital in the emergency room, it was found that emergency department physicians received 13.75 alerts for every 100 orders entered. Two-thirds were overridden, which is considered significant and has great potential for increased patient harm (Yoo et al, 2020). Providers are inundated with alarms and alerts throughout their shift and some are silenced and ignored which can have adverse outcomes for patients. Studies like this are imperative in performance improvement initiatives for CDSS programs and workflow processes for providers.
- Increased use of technology time
Providers may spend more time using technology and less time with patients due to flow of the system, placing orders, difficulty in finding what they need within the system, and answering alerts and alarms. This can lead to frustration for the provider and patient, and decrease satisfaction for both (Keasberry et al, 2017).
Mr. X came into clinic today for a follow up for his chronic atrial fibrillation. He has expressed concern about risk of stroke and bleeding, and has shared those concerns with me, his APN. It is estimated that 2.3 million Americans suffer from atrial-fibrillation (AF) and that number is growing with an expected 10 million by 2050 (Stacy et al, 2022). There are many tools through CDSSs that may help with AF including apps that monitor cardiac rate and rhythms, and medications. By inputting Mr. X’s information such as lab results, medications, and diagnosis of AF, the CDSS will guide me to make the best clinical decisions to manage his care that is evidenced based. The CDSS can be overridden if clinical judgement warrants. The CDSS can be beneficial in alerting providers to those who may be at higher risk for bleeding due to treatment with warfarin based on their lab results. It can also give dosage recommendations or offer other treatment options. As a new APN, this CDSS tool is helpful as it has the clinical guidelines, recommendations, and alerts built in to one system (Stacy et al, 2022)
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