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A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: a two-armed randomized controlled trial

A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: a two-armed randomized controlled trial
A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: a two-armed randomized controlled trial
Background: Frail older people admitted to nursing homes are at risk of a range of adverse outcomes, including pressure ulcers. Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals.
Objectives: To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention improves
adherence to recommendations for pressure ulcer prevention in nursing homes.
Design: Two-armed randomized controlled trial in a nursing home setting in Belgium. The trial consisted of a 16-week implementation intervention between February and June
2010, including one baseline, four intermediate, and one post-testing measurement.Primary outcome was the adherence to guideline-based care recommendations (in terms
of allocating adequate pressure ulcer prevention in residents at risk). Secondary outcomes were the change in resident outcomes (pressure ulcer prevalence) and intermediate outcomes (knowledge and attitudes of healthcare professionals).
Setting: Random sample of 11 wards (6 experimental; 5 control) in a convenience sample of 4 nursing homes in Belgium.
Participants: In total, 464 nursing home residents and 118 healthcare professionals participated.
Methods: The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system, including interactive education,
reminders, monitoring, feedback and leadership. The control arm received a hard-copy of the pressure ulcer prevention protocol, supported by standardized 30 min group lecture.
Results: Patients in the intervention arm were significantly more likely to receive fully adequate pressure ulcer prevention when seated in a chair (F = 16.4, P = 0.003). No significant improvement was observed on pressure ulcer prevalence and knowledge of the professionals. While baseline attitude scores were comparable between both groups [exp.74.3% vs. contr. 74.5% (P = 0.92)], the mean score after the intervention was 83.5% in the experimental group vs. 72.1% in the control group (F = 15.12, P < 0.001).
0020-7489
475-486
Beeckman, D.
b511e754-d654-4151-b3cb-65e92965207d
Clays, E.
c3c331c4-708c-421c-96d0-d324ba476a0e
Van Hecke, A.
094eb12d-9032-412f-95ad-43d519aa8933
Vanderwee, K.
cbdc355d-f85f-451b-ad07-6cc8653c9689
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Verhaeghe, S. A.
190198c9-fc64-412d-bf34-e0bad936b94b
Beeckman, D.
b511e754-d654-4151-b3cb-65e92965207d
Clays, E.
c3c331c4-708c-421c-96d0-d324ba476a0e
Van Hecke, A.
094eb12d-9032-412f-95ad-43d519aa8933
Vanderwee, K.
cbdc355d-f85f-451b-ad07-6cc8653c9689
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Verhaeghe, S. A.
190198c9-fc64-412d-bf34-e0bad936b94b

Beeckman, D., Clays, E., Van Hecke, A., Vanderwee, K., Schoonhoven, Lisette and Verhaeghe, S. A. (2012) A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: a two-armed randomized controlled trial. International Journal of Nursing Studies, 50 (4), 475-486. (doi:10.1016/j.ijnurstu.2012.09.007).

Record type: Article

Abstract

Background: Frail older people admitted to nursing homes are at risk of a range of adverse outcomes, including pressure ulcers. Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals.
Objectives: To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention improves
adherence to recommendations for pressure ulcer prevention in nursing homes.
Design: Two-armed randomized controlled trial in a nursing home setting in Belgium. The trial consisted of a 16-week implementation intervention between February and June
2010, including one baseline, four intermediate, and one post-testing measurement.Primary outcome was the adherence to guideline-based care recommendations (in terms
of allocating adequate pressure ulcer prevention in residents at risk). Secondary outcomes were the change in resident outcomes (pressure ulcer prevalence) and intermediate outcomes (knowledge and attitudes of healthcare professionals).
Setting: Random sample of 11 wards (6 experimental; 5 control) in a convenience sample of 4 nursing homes in Belgium.
Participants: In total, 464 nursing home residents and 118 healthcare professionals participated.
Methods: The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system, including interactive education,
reminders, monitoring, feedback and leadership. The control arm received a hard-copy of the pressure ulcer prevention protocol, supported by standardized 30 min group lecture.
Results: Patients in the intervention arm were significantly more likely to receive fully adequate pressure ulcer prevention when seated in a chair (F = 16.4, P = 0.003). No significant improvement was observed on pressure ulcer prevalence and knowledge of the professionals. While baseline attitude scores were comparable between both groups [exp.74.3% vs. contr. 74.5% (P = 0.92)], the mean score after the intervention was 83.5% in the experimental group vs. 72.1% in the control group (F = 15.12, P < 0.001).

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Published date: April 2012
Organisations: Faculty of Health Sciences

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Local EPrints ID: 351732
URI: https://eprints.soton.ac.uk/id/eprint/351732
ISSN: 0020-7489
PURE UUID: 4d99f775-b309-485e-9ad8-e1e584fb1871
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 24 Apr 2013 13:53
Last modified: 29 Oct 2019 01:41

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