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Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use.

Publication ,  Journal Article
Vandenberg, AE; Vaughan, CP; Stevens, M; Hastings, SN; Powers, J; Markland, A; Hwang, U; Hung, W; Echt, KV
Published in: Int J Qual Health Care
February 1, 2017

QUALITY PROBLEM OR ISSUE: Clinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers. INITIAL ASSESSMENT: Existing prescribing order entry processes were mapped at an initial Veterans Administration Medical Center site, demonstrating cognitive burden, effort and safety concerns. CHOICE OF SOLUTION: Geriatric order sets incorporating 2012 Beers guidelines and including geriatric prescribing advice and prepopulated order options were developed. IMPLEMENTATION: Geriatric order sets were implemented at two sites as part of the multicomponent 'Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department' quality improvement initiative. EVALUATION: Facilitators and barriers to order sets use at the two sites were evaluated. Phone interviews were conducted with two provider groups (n = 20), those 'EQUiPPED' with the interventions (n = 10, 5 at each site) and Comparison providers who were only exposed to order sets through a clickable option on the ED order menu within the patient's medical record (n = 10, 5 at each site). All providers were asked about order set 'use' and 'usefulness'. Users (n = 11) were asked about 'usability'. LESSONS LEARNED: Order set adopters described 'usefulness' in terms of 'safety' and 'efficiency', whereas order set consultants and order set non-users described 'usefulness' in terms of 'information' or 'training'. Provider 'autonomy', 'comfort' level with existing tools, and 'learning curve' were stated as barriers to use. CONCLUSIONS: Quantifying efficiency advantages and communicating safety benefit over preexisting practices and tools may improve adoption of CDS in ED and in other settings of care.

Duke Scholars

Published In

Int J Qual Health Care

DOI

EISSN

1464-3677

Publication Date

February 1, 2017

Volume

29

Issue

1

Start / End Page

117 / 123

Location

England

Related Subject Headings

  • Quality Improvement
  • Humans
  • Hospitals, Veterans
  • Health Policy & Services
  • Emergency Service, Hospital
  • Drug Prescriptions
  • Decision Support Systems, Clinical
  • Aged, 80 and over
  • Aged
  • 4407 Policy and administration
 

Citation

APA
Chicago
ICMJE
MLA
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Vandenberg, A. E., Vaughan, C. P., Stevens, M., Hastings, S. N., Powers, J., Markland, A., … Echt, K. V. (2017). Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use. Int J Qual Health Care, 29(1), 117–123. https://doi.org/10.1093/intqhc/mzw129
Vandenberg, Ann E., Camille P. Vaughan, Melissa Stevens, Susan N. Hastings, James Powers, Alayne Markland, Ula Hwang, William Hung, and Katharina V. Echt. “Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use.Int J Qual Health Care 29, no. 1 (February 1, 2017): 117–23. https://doi.org/10.1093/intqhc/mzw129.
Vandenberg AE, Vaughan CP, Stevens M, Hastings SN, Powers J, Markland A, et al. Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use. Int J Qual Health Care. 2017 Feb 1;29(1):117–23.
Vandenberg, Ann E., et al. “Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use.Int J Qual Health Care, vol. 29, no. 1, Feb. 2017, pp. 117–23. Pubmed, doi:10.1093/intqhc/mzw129.
Vandenberg AE, Vaughan CP, Stevens M, Hastings SN, Powers J, Markland A, Hwang U, Hung W, Echt KV. Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use. Int J Qual Health Care. 2017 Feb 1;29(1):117–123.
Journal cover image

Published In

Int J Qual Health Care

DOI

EISSN

1464-3677

Publication Date

February 1, 2017

Volume

29

Issue

1

Start / End Page

117 / 123

Location

England

Related Subject Headings

  • Quality Improvement
  • Humans
  • Hospitals, Veterans
  • Health Policy & Services
  • Emergency Service, Hospital
  • Drug Prescriptions
  • Decision Support Systems, Clinical
  • Aged, 80 and over
  • Aged
  • 4407 Policy and administration