Using clinical decision support tools to increase defibrillator deactivations in dying patients

[摘要] Inadvertent automatic implantable cardioverterdefibrillator (AICD) shocks at the end of life aredistressing and should be avoided.1 2 Up to 65%of AICDs are active and up to 33% of patientswith AICDs receive shocks within 24 hours ofdying.3 Though guidelines encourage devicediscussions, one study demonstrated only 27%of clinicians brought up AICD deactivation.2 4Since the Health Information Technology forEconomic and Clinical Health Act was passed in2009, clinicians and IT professionals introducedevidence-based clinical decision support (CDS)models into patient care, including order setsand alerts.5 Our group was the first to demonstrate that educational sessions paired with anovel CDS tool in the electronic medical record(EMR) significantly improved the rates of AICDdeactivation discussions and of shock functiondeactivation.6 However, a criticism was that thelabour-intensive teaching sessions drove mostof the improvement and EMR modificationsare ineffective. As a result, we sought to investigate whether the CDS tool alone invoked moreAICD deactivation discussions and AICD deactivations.

[学科分类] 药学

[关键词] Healthcare quality improvement;Patient-centred care;Decision support;clinical