Evaluating the Effectiveness of Nurse-Focused Computerized Clinical Decision Support on Urinary Catheter Practice Guidelines

A growing national emphasis has been placed on health information technology (HIT) with robust computerized clinical decision support (CCDS) integration into health care delivery. Catheter-associated urinary tract infection is the most frequent health care-associated infection in the United States and is associated with high cost, high volumes and determined to be preventable through the application of evidence-based guidelines. The purpose of this quasi-experimental, ex post facto study was to evaluate the impact of an evidence-based practice guideline computerized clinical decision support (CCDS) intervention in patients with a urinary catheter device. Correlational relationships were explored among patient and nurse-specific demographics as related to acceptance or rejection of the CCDS alert and resulting guideline compliance. The CCDS used in this study involved a time-specific, computer-generated workflow alert that appeared on the computer 48 hours after the nurse electronically documented the presence and/or placement of a urinary catheter in the patient's electronic health record (EHR). Compliance with the evidence-based guidelines and patient and nurse-specific demographic data were evaluated through the retrospective EHR review of 311 patients for similar six-month time periods preceding and following the CCDS implementation. Data were analyzed using independent samples t-tests and Pearson's correlation coefficient. The post-implementation group had statistically significant improvement in guideline compliance and positive correlations were shown between the patient's age, care delivery unit and primary diagnosis. There were no statistically significant correlations shown among the other demographics. The role of nurse-focused CCDS is a promising new area in nursing care delivery and warrants further investigation.