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Cited by 100Pressure Ulcer Prevention and ManagementHealth Policy Implementation ScienceElectronic Health Records Systems

A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: a two-armed randomized controlled trial

Beeckman, Dimitri, Clays, Els, Van Hecke, Ann, Vanderwee, Katrien, Schoonhoven, Lisette, Verhaeghe, Sofie·2013·International Journal of Nursing Studies
DOI 10.1016/j.ijnurstu.2012.09.007
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Abstract

Background Frail older people admitted to nursing homes are at risk of a range of adverse outcomes, including pressure ulcers. Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals.Objectives To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention improves adherence to recommendations for pressure ulcer prevention in nursing homes.Design Two-armed randomized controlled trial in a nursing home setting in Belgium. The trial consisted of a 16-week implementation intervention between February and June 2010, including one baseline, four intermediate, and one post-testing measurement. Primary outcome was the adherence to guideline-based care recommendations (in terms of allocating adequate pressure ulcer prevention in residents at risk). Secondary outcomes were the change in resident outcomes (pressure ulcer prevalence) and intermediate outcomes (knowledge and attitudes of healthcare professionals).Setting Random sample of 11 wards (6 experimental; 5 control) in a convenience sample of 4 nursing homes in Belgium.Participants In total, 464 nursing home residents and 118 healthcare professionals participated.Methods The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system, including interactive education, reminders, monitoring, feedback and leadership. The control arm received a hard-copy of the pressure ulcer prevention protocol, supported by standardized 30 min group lecture.Results Patients in the intervention arm were significantly more likely to receive fully adequate pressure ulcer prevention when seated in a chair (F=16.4, P=0.003). No significant improvement was observed on pressure ulcer prevalence and knowledge of the professionals. While baseline attitude scores were comparable between both groups [exp. 74.3% vs. contr. 74.5% (P=0.92)], the mean score after the intervention was 83.5% in the experimental group vs. 72.1% in the control group (F=15.12, P<0.001).Conclusion The intervention was only partially successful to improve the primary outcome. Attitudes improved significantly while the knowledge of the healthcare workers remained unsatisfactorily low. Further research should focus on the underlying reasons for these findings.

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Crossref · 10.1016/j.ijnurstu.2012.09.007

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  • For the eight studies with a non-tailored control intervention included in meta-regression, the pooled odds ratio was 1.79 (95% CI 1.06 to 3.01, P = 0.033).

    “Eight of these were included in a meta‐regression; the pooled odds ratio was 1.79 (95% CI 1.06 to 3.01, P value = 0.033) (Baker 2001; Beeckman 2013; Cheater 2006; Coenen 2004; Evans 1997; Fretheim 2006; Leviton 1999; Simon 2005).”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as Beeckman 2013

  • One study delivered a group lecture and distributed the standard protocol to the control group.

    “One study delivered a group lecture and distributed the standard protocol to the control group (Beeckman 2013).”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as Beeckman 2013

  • Removing Beeckman 2013 from the meta-regression gave a pooled odds ratio of 1.48 (95% CI 1.24 to 1.75, P = 0.002).

    “Removing this study from the meta‐regression gave a pooled odds ratio of 1.48 (95% CI 1.24 to 1.75, P value = 0.002) (plots for these two comparisons are shown in Figure 5 and Figure 6).”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as Beeckman 2013

  • The overall risk of bias for Beeckman 2013 was unclear (2 unclear risk, 1 high risk criteria).

    “Risk of bias overall Unclear risk 2 unclear risk, 1 high risk criteria”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as Beeckman 2013

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Authors
Beeckman, D., Clays, E., Van Hecke, A., Vanderwee, K., Schoonhoven, L., & Verhaeghe, S.
Affiliations
  • King's College London (GB)
  • Ghent University (BE)
  • Radboud University Medical Center (NL)
Corresponding author
Beeckman, Dimitri
ORCID
Venue
International Journal of Nursing Studies
Publisher
Elsevier BV
Published
2013-04
Volume
50
Issue
4
Pages
475-486
ISSN
0020-7489 (ISSN-L)
DOI
10.1016/j.ijnurstu.2012.09.007
OpenAlex
W2170619355
Cited by
100
References
46
Citations by year
2026: 6 · 2025: 6 · 2024: 5 · 2023: 8 · 2022: 14 · 2021: 10 · 2020: 11 · 2019: 9 · 2018: 3 · 2017: 4 · 2016: 5 · 2015: 7 · 2014: 6 · 2013: 3 · 2012: 2
FWCI
17.69
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • International Journal of Nursing Studies (publishedVersion)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Topics
  • Health Sciences › Health Professions › Occupational Therapy › Pressure Ulcer Prevention and Management
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords
pressure ulcer prevention, clinical decision support systems, nursing homes, implementation strategies, guideline adherence, frail elderly, pressure ulcer prevalence, employee training
MeSH terms
Adult, Belgium, Pressure Ulcer, Female, Humans, Male, Middle Aged, Nursing Homes, Guideline Adherence, Decision Support Systems, Clinical

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