Safety First Blog

Analysis of Clinical Decision Support at the Point of Care

Posted by Laura Paxton on Mar 29, 2021 10:54:51 AM
Laura Paxton
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The Importance of Simplifying Safety Information Access at the Point-Of-Care

Doctor checking heart beat of patient in bed with stethoscope with nurse adjusting I-1It seems obvious that more safety information available at the point of care equals better patient care. However, more is not always better when it comes to information needed to make quick decisions on behalf of patients. 

Most clinicians currently search through 6 or 7 systems or websites taking at least 20 clicks to get the safety information needed to care for patients. Even when these links are available in the EHR the search for information still takes far too long and creates opportunities for med errors. Link fatigue is real, am I right? 

Bates, Kuperman, and Wang’s 10 Commandments for CDS agree and says, “Speed can mean life or death in patient care.” Unfortunately, most hospitals’ EHR and CDS are not set up for speed. 

Speed is nothing without accuracy. When clinicians either encounter multiple links to get the information they need and/or the links in the EHR and ERx are broken, clinicians lose confidence in the information. The challenges compound and it’s the patients who could suffer. 

We were curious about how much of an impact simplifying the route to vital safety information would have in terms of how often clinicians would access it and what information they actually would access. We expected an increase of maybe 35% but actually found that 85-90% of clinicians were more likely to use safety information if it was easily accessible at the point of care. When they have to interrupt their workflow and leave the EHR to go to Sharepoint or another app to find it, they just won’t. 

This data was gathered when we compared our clients who use our FormWeb formulary solution inside of Epic vs. clients who were using FormWeb outside of Epic. We were stunned at the huge jump in increased access when FormWeb was used inside of Epic. That one leap outside of the EHR presents a challenge even when FormWeb serves as the one-stop resource for all of a hospital’s detailed formulary information. 

A Porter Research survey backs this up. The healthcare CIOs surveyed said by far the greatest challenge they face when managing large-scale clinical content is ensuring clinician access to the information. 

So we have the information, but how do we make sure doctors, nurses, and pharmacists can quickly and easily get to it when treating patients? 

Recently, the primary site editor of one of our long-time FormWeb customers retired and a new team is looking at the software with fresh eyes. They are interfaced with Epic so we started studying their analytics to see what content is used and what needs to be refreshed. We found that 60% of their searches are actually looking at the CDS in a drug monograph. We also found that the greatest users of their site are the nurses, not pharmacists; a surprise to us and to our client. About 8 years ago they removed the nurse link from the MAR, but after our analysis, they will be adding that link back into their MAR. We’ll be interested to do a follow-up analysis and see how this small change affects access. 

Bottom line from our findings: If you provide a mechanism for all clinical safety information in one place at the point-of-care, clinicians will trust and use it and patient health and safety will significantly improve. 

*Of note, we’re working to make the complete findings available on our website shortly. 

Topics: Rhazdrugs, Policy, USP <800>, Formweb

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