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How do nurses use new technologies to inform decision making?

How do nurses use new technologies to inform decision making?. Project Aims. Identify areas of practice in the NHS where new decision support technologies have been introduced or where their introduction is imminent

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How do nurses use new technologies to inform decision making?

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  1. How do nurses use new technologies to inform decision making?

  2. Project Aims • Identify areas of practice in the NHS where new decision support technologies have been introduced or where their introduction is imminent • Explore how new technologies are used to inform decision making in practice and the potential effect these may have on the care delivery process and patient outcomes • Examine the role of education and training in the introduction of new technologies in practice.

  3. Methods • Systematic review • Survey of NHS Trusts • Secondary analysis of existing data sets • Case study

  4. Systematic Review Update

  5. Comparisons • Nurses using CDSS v. nurses not using CDSS • Nurses using CDSS v. other health professionals not using CDSS • Health professionals using CDSS v. health professionals not using CDSS, where nurses were a subgroup of the participants

  6. Articles identified through database searching and screened (n=6885) Excluded (n=6552): Duplicates (n=15) Not about CDSS (n=5664) Not about nurses (n=304) Not original research article (n=569) Potentially relevant articles retrieved in full text for screening using full set of inclusion criteria (n=333) Excluded (n=362): Intervention not CDSS (n=119) Not original research article (n=111) CDSS not used by nurses (n=87) Not RCT/CBA/CCT/ITS (n=41) Intervention not evaluated in real clinical setting (n=2) Did not provide measurable outcomes (n=2) Articles identified through searching of reference lists and contacting authors and experts in the field, retrieved in full text for screening (n=49) Articles included in review (n=20)

  7. Comparison 1 • 3 studies • Anticoagulation management • Triage (NHS Direct vs. practice nurse) • Glucose regulation in ICU • Performance outcomes: 1 study suggests CDSS to be beneficial, 1 study suggests CDSS to be detrimental • Patient outcomes: 2 studies support hypothesis of no difference

  8. Comparison 2 • 5 studies • 3 studies of anticoagulation management • 2 studies of triage: 1 for out-of-hours care, 1 for same day appointment requests • Performance outcomes: 3 studies suggest CDSS to be beneficial • Patient outcomes: 4 studies suggest CDSS to show some benefit, 1 study suggests CDSS to be detrimental

  9. Currently… • Narrative summary • Visual and statistical analyses

  10. Survey Update

  11. Aims of the Survey • Provide data on the progress of implementing NPfIT in NHS Trusts • Identify current uses of CDSS by nurses in NHS trusts

  12. Method Survey in 2 parts • Part 1: Implementation of NPfIT & use of CDSS by nurses • Part 2: A more detailed picutre of the nature & purpose of the CDSS being used

  13. Pilot Study • 2 SHA’s • N = 29 (PCT 15; AT 10; MHT 4) • Response rate = 59% • 19 Part 2’s returned • 35% Trusts reported no CDSS at all • Varied settings for CDSS use • 26% of CDSS provides an automatic decision

  14. The Survey • 50% of each type of NHS Trust in England • N = 272 plus 4 additional Trusts • Chief Executive letters

  15. Randomised Trusts: 276 Trusts Refused: 74 Surveys sent out: 123 Surveys Returned: 64 Awaiting Response: 59 Response Rate

  16. How Do Nurses Use New Technologies to Inform Decision Making? Secondary Analysis Update January 2006

  17. Background Secondary analysis of data from two previous studies that have addressed aspects of the use of new technologies by nurses (i) DH funded evaluation of the Exemplar Programme for integrated out of hours care (ii) MRC-funded project looking at nurses’ use of research information in decision making in primary care.

  18. (i) Exemplar Evaluation data • Semi-structured interviews with 88 staff in 4 ‘Exemplars’ including nurses, nurse managers, general practitioners, other clinicians, call handlers, call centre managers and commissioners (Nov 2001to Jan 2002) • Primary focus was their experience of planning and implementing a new model of integrated out-of-hours care • Data refer to the use of NHS CAS: direct experiences of nurses using decision support, together with the observations of other staff of the impact of CDSS on the care of patients and on how staff practice.

  19. The patient makes a single call, forwarded automatically with an explanatory message Ambulance Information Service or health information Pharmacy Community Nursing NHS Direct Call Management and Nurse Triage Self care Accident & Emergency Out-of-Hours Dental Service Call back Patient or call centre initiated Advice Mental Health Out-of-Hours Team Social Services or Home Care Team GP later next day or routine appointment (direct booking to GP system) GP on the telephone Advice The Integrated Model Of Out-Of-Hours Care GP or Nurse Face-to-Face Consultation  In Primary Care Centre or Walk-in Centre  In A&E Primary Care Centre  At home

  20. (i) Exemplar Evaluation data • 53 selected for inclusion in the secondary analysis. • ‘Framework analysis’ method: familiarisation, identifying a thematic framework, indexing, charting, mapping and interpretation. • 45 interview transcripts indexed so far: all text relevant to each item in the index entered into a matrix in Excel.

  21. Reference to core questions in the ‘New Technologies’ Project: • How does unsupported decision making differ from nurse decision making when a CDSS (computerised decision support system) is in use? • What is the evidence that the outcomes of technology supported decisions are better then those of unsupported decisions? • What kinds of education and training do nurses need to use decision technologies in practice?

  22. (ii) Nurses’ use of research information in decision making in primary care. • Data collected between November 2001 and September 2002 across three sites. • Observations and interviews with practice nurses (approx. 30), district nurses (approx. 30), and health visitors (approx. 30). • Field notes from approximately 120 hours of observations have been collected. • Secondary analysis of this data is due to begin at the end of January 2006

  23. Case study

  24. Aims • How unsupported decision making differs from decision making when CDSS is in use? • What is the evidence that outcomes of technology supported decisions are better than those of unsupported decisions? • What kinds of education and training do nurses need to use new technologies in practice? • What are the characteristics of technology, organisation, individuals and decisions that are most likely to increase the use of new technolgies in the future?

  25. Case site selection DECISION MAKER Expertise Experience with technology Education and training DECISION TASK Type of decision Complexity SAMPLE TECHNOLOGY Mode of delivery of information User interface Purpose DECISION CONTEXT Type of setting Organisational culture Implementation methods Education and training

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