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

Academic Article

Abstract

  • 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.
  • Keywords

  • appropriateness, elderly < specific populations, emergency care < setting of care, qualitative methods < general methodology, quality improvement < quality management, under-use and over-use < appropriate healthcare, Aged, Aged, 80 and over, Decision Support Systems, Clinical, Drug Prescriptions, Emergency Service, Hospital, Hospitals, Veterans, Humans, Quality Improvement
  • Digital Object Identifier (doi)

    Pubmed Id

  • 8903584
  • Author List

  • Vandenberg AE; Vaughan CP; Stevens M; Hastings SN; Powers J; Markland A; Hwang U; Hung W; Echt KV
  • Start Page

  • 117
  • End Page

  • 123
  • Volume

  • 29
  • Issue

  • 1