Integrating evidence into clinical information systems for nursing decision support.

PURPOSE: To illustrate approaches for providing decision support for evidence-based nursing practice through integration of evidence into clinical information systems (CISs) with examples from our experience at Columbia University Medical Center. ORGANIZING CONSTRUCT: Examples are organized according to three types of decision support functions: information management, focusing attention, and patient-specific consultation. METHODS: Three decision support tools that are integrated into three types of CISs are discussed: (1) infobuttons that provide context-specific access to digital sources of evidence; (2) automated Fall-Injury Risk Assessment; and (3) personal digital assistant-based screening reminders, screening assessments, and tailored documentation templates for the identification and management of obesity, depression, and tobacco cessation. The informatics infrastructure for implementing these decision support tools is described from the perspective of components identified in the published literature. CONCLUSIONS: Efforts to facilitate application of evidence into nursing practice are unlikely to be successful unless the approaches used are integrated into the clinical workflow. Our approaches use a variety of informatics methods to integrate evidence into CISs as a mechanism for providing decision support for evidence-based practice in a manner consistent with nursing workflow.

PDA-based informatics strategies for tobacco use screening and smoking cessation management: a case study.

The purpose of this case study is to describe three incremental personal digital PDA-based informatics strategies aimed at improving screening for tobacco use and guideline-based tobacco cessation management: 1) PDA clinical log with tobacco cessation diagnoses and plan of care options, 2) PDA decision support system, and 3) PDA decision support system with infobuttons--context-specific links to the National Cancer Institute's Cancer Information Services tobacco cessation information. These strategies were implemented within the context of an evidence-based advanced practice nurse curriculum at the Columbia University School of Nursing.

Promoting patient safety through informatics-based nursing education.

The Institute of Medicine (IOM) Committee on Quality of Health Care in America identified the critical role of information technology in designing safe and effective health care. In addition to technical aspects such as regional or national health information infrastructures, to achieve this goal, healthcare professionals must receive the requisite training during basic and advanced educational programs. In this article, we describe a two-pronged strategy to promote patient safety through an informatics-based approach to nursing education at the Columbia University School of Nursing: (1) use of a personal digital assistant (PDA) to document clinical encounters and to retrieve patient safety-related information at the point of care, and (2) enhancement of informatics competencies of students and faculty. These approaches may be useful to others wishing to promote patient safety through using informatics methods and technologies in healthcare curricula.

Columbia University's competency and evidence-based Acute Care Nurse Practitioner Program.

New clinical information is being generated faster than practicing clinicians can effectively assimilate it. Since the gold standard of clinical information is evidence-based information, tools and techniques that facilitate both the building of evidence for practice and the application of evidence to practice are essential for practicing clinicians. As such, the Acute Care Nurse Practitioner (ACNP) program at Columbia University's School of Nursing was reconfigured to incorporate both theoretically based competency evaluation standards and strategies to foster an evidence-based practice approach to clinical care. The purpose of this article is to describe a curriculum and set of learning activities used to foster both development of clinical competency and evidence-based practice in students in the Acute Care Nurse Practitioner program.