Optimizing CDS to Decrease Alert Fatigue & Enhance Nursing Workflow  

Purpose: Clinical decision support (CDS) enhances health care by utilizing knowledge and available patient-specific data aids in decision-making at the most appropriate time in a clinical workflow. Best practice advisories/alerts (BPA) are one type of CDS. BPAs are used to notify healthcare professionals when there are tasks to be completed for a specific patient. Development of CDS is based on the principles of the five rights: information, people, format, channel, and time. This optimization used the five rights as a guide in optimizing the use of BPAs. For nurses at this institution, BPAs have a standard format and can be presented via several different channels. The BPAs that pop up often disrupt a nursing workflow. Nurses often experience alarm fatigue and frustration when exposed to an extreme number of medical alarms/alerts which leads to desensitization. This project’s goal was to increase the timely completion of required tasks and decrease the number of workflow disruption via pop-up BPAs.

Description: An area of the EHR at this institution is called the storyboard. It acts as a home base for clinicians. It appears on the left side of the screen whenever a patient chart is opened and is the location of much information about that patient (i.e., name, age, admission date, isolation). The storyboard was identified as a different channel to present BPAs as a response to the concerns of the nurses. A storyboard BPA is non-intrusive, stays available on the left panel of a patient chart, and is colorized to increase visibility. Pop-up BPAs will occur to notify the nurse of an action needed, but the nurse can defer it knowing they can return to the required tasks on the storyboard at a time that is appropriate in their workflow. For this project, an inventory of BPAs was obtained and reviewed, and revisions were made guided by the five rights of CDS. Lockout times for pop-up BPAs to reappear have been increased from 1 to 4 hours to reduce the number of BPAs popping up. Lastly, storyboard BPAs were created to supplement pop-up BPAs and provide a place where nurses can address the actions needed at an appropriate time in their workflow.

Evaluation/outcome: In a 2-month period prior to this project, 283,196 BPAs fired for inpatient registered nurses at this institution. Post-implementation comparison data is pending. The number of BPA firings, number of active BPAs, and time from initial BPA to resolution of actions will be compared pre- and post-implementation. We will also gather nurses’ feedback on the BPA optimization process and outcome.