Abstract
We have developed a Pressure Ulcer Prevention and Management System to assist clinicians with patient-specific decision making. The system captures coded data about assessment, diagnosis and interventions using a point-and-click interface. Guideline-based knowledge is imbedded into the system, and is accessible in several ways: 1) via hypertext links from the data entry screens; 2) via explicit entry into an indexed version of the guideline; 3) via imbedded knowledge-based rules that critique the diagnosis and offer guidance for treatment; and 4) via explicit entry into interactive algorithms. The system has been implemented experimentally on one care unit at our hospital, where its impact will be assessed in comparison with a control unit. Preliminary usage data are provided. Issues with rendering guideline material useful for patient-specific decision support are discussed. In our setting, these issues had to do with a) incongruity with local standards; b) insufficient specificity; and 3) insufficient comprehensiveness. Issues of use and dissemination in the context of today's health care environment are also addressed.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Allman R. M., Laprade C. A., Noel L. B., Walker J. M., Moorer C. A., Dear M. R., Smith C. R. Pressure sores among hospitalized patients. Ann Intern Med. 1986 Sep;105(3):337–342. doi: 10.7326/0003-4819-105-3-337. [DOI] [PubMed] [Google Scholar]
- Lomas J., Anderson G. M., Domnick-Pierre K., Vayda E., Enkin M. W., Hannah W. J. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med. 1989 Nov 9;321(19):1306–1311. doi: 10.1056/NEJM198911093211906. [DOI] [PubMed] [Google Scholar]
- Meehan M. Multisite pressure ulcer prevalence survey. Decubitus. 1990 Nov;3(4):14–17. doi: 10.1097/00129334-199011000-00006. [DOI] [PubMed] [Google Scholar]
- Michocki R. J., Lamy P. P. The problem of pressure sores in a nursing home population: statistical data. J Am Geriatr Soc. 1976 Jul;24(7):323–328. doi: 10.1111/j.1532-5415.1976.tb06804.x. [DOI] [PubMed] [Google Scholar]
- Moody B. L., Fanale J. E., Thompson M., Vaillancourt D., Symonds G., Bonasoro C. Impact of staff education on pressure sore development in elderly hospitalized patients. Arch Intern Med. 1988 Oct;148(10):2241–2243. [PubMed] [Google Scholar]
- Tierney W. M., Overhage J. M., Takesue B. Y., Harris L. E., Murray M. D., Vargo D. L., McDonald C. J. Computerizing guidelines to improve care and patient outcomes: the example of heart failure. J Am Med Inform Assoc. 1995 Sep-Oct;2(5):316–322. doi: 10.1136/jamia.1995.96073834. [DOI] [PMC free article] [PubMed] [Google Scholar]