Construction And Application Of Clinical Decision Support System For Delirium Management In ICU Patients

ObjectiveBy constructing and applying the clinical decision support system for delirium management in ICU,evidence-based nursing,information technology,and clinical practice are combined,and the intelligent input,intelligent generation,intelligent reminder,and other functions of the decision support system are used to automatically process the collected patient information,judge the delirium risk level of patients,and generate personalized delirium nursing measures for patients.To help clinical medical staff make the best clinical decision,realize intelligent nursing,ensure the scientific nursing measures,and rove the quality of clinical delirium nursing.Methods1.①Systematic search of Joanna Briggs Institute Database of evidence-based Health care Centers,UpToDate,British Medical Journal best practice,BMJ,the Cochrane Library,the Scottish Intercollegiate Guidelines Network,the UK’s National Institute for Health and Care Excellence website,the Guidelines International Network website,Chinese Medical Maitong Guide,American Delirium Society website,European Delirium Association website,PubMed,Embase,CINAHL,China National Knowledge Network,Wanfang database,China biomedical database and other relevant guidelines on delirium management in ICU patients,professional(industry)standards,expert consensus,systematic review,evidence summary,best practice recommendation evidence,etc.After the evaluation of literature quality and grading of evidence,relevant literature was processed and reviewed.By using the literature review method,based on the recommendations of the guidelines for the management of delirium in ICU patients,combined with the professional judgment of nurses,the needs of patients and their families,and the clinical practice environment,the evidence-based and operable intervention measures for the management of delirium in ICU patients were developed,and the draft of the knowledge base for the hierarchical management of delirium in ICU patients was formed.② The effective recovery rates of the 2 rounds of correspondence questionnaires were 95%and 100%,respectively,and the degree of expert authority of the 2 rounds of correspondence questionnaires was 0.91.In the first round of correspondence,the Kendall harmony coefficient of each level of entries was 0.135～0.171.In the second round of correspondence,the Kendall harmony coefficient of each level of entries was 0.313～0.595.The final draft of the ICU delirium management knowledge base based on the early delirium risk prediction model was formed based on the experts’ opinions,including 6 first-level items,19 second-level items and 50 third-level items.2.The clinical decision system of delirium management for patients in ICU is guided by a nursing risk management program,based on an electronic medical record system,based on the construction of ICU patient delirium management knowledge base,through logical reasoning and human-computer interaction technology to analyze and process the data,and output the decision results.3.The system was officially used in the ICU ward of a tertiary A hospital in Jiangsu Province from June 2022.A quasi-experimental study was conducted,with 107 ICU patients after the system application from June 2022 to August 2022 as the experimental group,and 96 ICU patients before the system application from January 2022 to April 2022 as the control group.ICU delirium prevention management protocol was adopted in the experimental group,and routine delirium care was adopted in the control group.The incidence of delirium in the ICU,the time to first receiving delirium prevention measures,the time to write nursing notes and the rate of record defects,and the satisfaction of nurses with the clinical decision support system for the management of delirium in ICU patients were evaluated.Delirium was evaluated by ICU fuzzy consciousness evaluation method,and nurses’ satisfaction with the clinical decision support system for delirium management of ICU patients was measured by the clinical nursing information system effectiveness evaluation scale.Results1.Construct the knowledge base of a clinical decision system for delirium management of ICU patients① A total of 1911 relevant literature were retrieved.According to the inclusion and exclusion criteria,12 pieces of literature were selected.The measures in the literature were summarized to form the first draft of the ICU delirium management knowledge base.②Effective recovery rates of the two rounds of correspondence were 95%and 100%,respectively,and the degree of expert authority of the two rounds of correspondence was 0.91.In the first round of correspondence,the Kendall harmony coefficient was 0.135～0.171;In the second round of correspondence,the Kendall harmony coefficient was 0.313～0.595.According to the experts’ opinions,a hierarchical management scheme for the prevention of delirium in ICU patients was finally formed based on the early delirium prediction model,including 6 first-level items,19 second-level items,and 50 third-level items.2.Design and develop a clinical decision support system module for delirium management of ICU patientsThe clinical decision system of delirium management for patients in ICU automatically calculates the delirium risk value of patients in ICU according to the basic information of patients in the electronic medical record system,disease characteristic information and input disease classification information,intelligently judges the risk level of patients according to the delirium risk value,and automatically pushes standardized nursing measures and review reminders in the knowledge base for patients with different delirium risk levels.Form nursing tasks,timely and accurately guide nursing staff in different clinical situations to carry out correct clinical decisions.3.Application of clinical decision support system for delirium management in ICU patientsAfter the use of clinical decision support system for delirium management in ICU patients,the incidence of delirium in ICU patients,the time for patients to receive delirium prevention measures for the first time,the time for writing nursing records,and the rate of writing defects of nursing records in ICU patients were all reduced,and the differences were statistically significant compared with before the use of the decision support system(P<0.05);The overall satisfaction score of nursing staff to the system was(100.88±4.06),which was at a high level.Conclusions1.The hierarchical management scheme for preventing delirium in ICU patients based on the early delirium prediction model is scientific,reliable,targeted,and operable,and can provide a reference for preventing and managing delirium in ICU in the future.2.The constructed clinical decision support system for delirium management in ICU patients can effectively reduce the incidence of delirium in ICU patients,shorten the response time of preventive intervention,reduce the rate of nursing record-writing defects,and ensure the safety of patients.