College of Nursing Assistant Professor Anna Krupp, PhD, MSHP, RN and Associate Professor Karen Dunn Lopez, PhD, MPH, RN, FAAN understand that intensive care unit (ICU) patients have a greater chance of developing functional decline, which may include new limitations in walking or a decreased ability to manage basic physical needs after hospital discharge. One common contributing factor for this is long periods of immobility, or remaining in bed, during ICU hospitalization.
With funding from the Agency for Healthcare Research and Quality, Krupp and Dunn Lopez are proposing to develop a decision support tool in the electronic health record. The goal is to make complex decisions about when it is safe to assist ICU patients out of bed more efficient for nurses. Currently, nurses look in multiple locations in the EHR for this information. The tool will summarize key patient information on one screen.
“ICU nurses make hundreds of decisions during a shift and the decision to assist a patient to sit on the edge of the bed or walk in the room requires that nurses know a lot about the patient and their stability over the previous shift,” said Clinical Assistant Professor and Co-Investigator Heather Dunn, PhD, ACNP-BC, ARNP. “Enhancing mobility in the ICU is crucial for positive patient outcomes. However, assessing readiness for activities like walking is challenging when data needs to be gathered from multiple sections of the medical record.”
The project will be conducted in two phases. First, they’ll develop the decision support tool with input from practicing ICU nurses. Next, the tool will be studied in two environments—a simulated EHR with nurses from across the nation and a real-world trial in the ICU.
Both Krupp and Dunn Lopez bring differing expertise. Dunn Lopez will use her knowledge with usability science and focus her time in a simulated setting identifying the ease, use, and effectiveness of the tool.
“One thing we know is that if something is not easy to use, it isn’t going to get used. But there are methods that can make sure that what you are developing is useful to the people who use it,” Dunn Lopez said.
Krupp will apply her ICU-based clinical expertise with her implementation science training to plan and study how decision support is used in everyday clinical practice.
“The best-designed tool does not guarantee routine use in complex healthcare settings. Implementation science identifies and addresses contextual factors to help promote its use,” said Krupp.
Krupp and Dunn Lopez suspect the results of the study will influence a “pragmatic way of accelerating the use of patient data with guideline recommendations at the point of care to support ICU clinicians in delivering evidence-based care, decreasing the duration of bed rest, and reducing hospital-acquired functional decline.”