JMIR Publications

ABSTRACT

Background:

The clinical decision-making process in pressure ulcer (PU) management is complex and its quality depends on both the nurse's experience and the availability of scientific knowledge. This process should follow evidence-based practice incorporating health information technologies to assist healthcare professionals, such as the use of Clinical Decision Support Systems (CDSS). These systems, in addition to increasing the quality of care provided, can reduce errors and costs in healthcare. However, the widespread use of CDSS still has limited evidence, noting the need to identify and evaluate its effects on nursing clinical practice.

Objective:

To identify the effects on clinical decision-making of nurses using CDSS for PU management.

Methods:

The systematic review was conducted in accordance with the PRISMA recommendation. Search was conducted in April 2019 on five electronic databases: MEDLINE, SCOPUS, Web of Science, Cochrane, and CINAHL, without publication date or study design restrictions. Articles that addressed the use of computerized CDSS in PU care and applied in clinical practice were included. Handsearching in the reference lists of eligible articles was considered. The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of the studies.

Results:

The search strategy resulted in 998 articles, 16 of which were included. The year of publication ranged from 1995 to 2017, with 45% of studies conducted in the United States. Most addressed the use of CDSS by nurses, in PUs prevention, in inpatient units. All studies described knowledge-based systems that assessed the effects on clinical decision-making, clinical effects secondary to CDSS use, or factors that influenced the use/intention to use CDSS by health professionals and the success of their implementation in nursing practice.

Conclusions:

The effects of CDSS used by nurses in the management of PUs lack results of high evidence in the literature. No significant effects were found on nurses' knowledge following the integration of CDSS into the workflow, with assessments made for a brief period of up to six months. Clinical effects, such as outcomes in the incidence and prevalence of PUs, remain limited in the studies, and most find clinically significant, but non-statistically significant results in decreasing PUs. It is necessary to carry out studies that have nurses as the focus of intervention, with a representative sample, randomized study designs, and application of appropriate assessment instruments. In addition, a longer-term follow-up to assess the effects of CDSS that may demonstrate a more real, measurable, and significant effect on clinical decision-making is needed. Clinical Trial: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019127663; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127663