Abstract
The selection of appropriate wound products for the treatment of pressure injuries is paramount in promoting wound healing. However, nurses find it difficult to decide on the most optimal wound product(s) due to limited live experiences in managing pressure injuries resulting from successfully implemented pressure injury prevention programs. The challenges of effective decision-making in wound treatments by nurses at the point of care are compounded by the yearly release of wide arrays of newly researched wound products into the consumer market. A clinical decision support system for pressure injury (PI-CDSS) was built to facilitate effective decision-making and selection of optimal wound treatments. This paper describes the development of PI-CDSS with an expert knowledge base using an interactive development environment, Blaze Advisor. A conceptual framework using decision-making and decision theory, knowledge representation, and process modelling guided the construct of the PI-CDSS. This expert system has incorporated the practical and relevant decision knowledge of wound experts in assessment and wound treatments in its algorithm. The construct of the PI-CDSS is adaptive, with scalable capabilities for expansion to include other CDSSs and interoperability to interface with other existing clinical and administrative systems. The algorithm was formatively evaluated and tested for usability. The treatment modalities generated after using patient-specific assessment data were found to be consistent with the treatment plan(s) proposed by the wound experts. The overall agreement exceeded 90% between the wound experts and the generated treatment modalities for the choice of wound products, instructions, and alerts. The PI-CDSS serves as a just-in-time wound treatment protocol with suggested clinical actions for nurses, based on the best evidence available.
Highlights
As the population advances in age and weight, pressure injuries become more prevalent in healthcare systems
This paper aimed to describe the empirical approach in developing a Pressure Injury Clinical Decision Support System (PI-clinical decision support system (CDSS)), and, secondly, to examine the consistency of the recommendations made by the pressure injury (PI)-CDSS
The project started with literature reviews on evidence-based treatment, moved to eliciting expert knowledge that mimicked the experts’ mindset in wound treatment, applying the PI-CDSS via other heterogeneous administrative and clinical systems, and conducting formative evaluation on the consistency of the decision options provided by the CDSS against the recommendations of the wound experts
Summary
As the population advances in age and weight, pressure injuries become more prevalent in healthcare systems. The numbers of pressure injuries are expected to increase exponentially with the compounding effects of complications arising from chronic diseases. Pressure injuries tend to affect the frail, elderly, bed-bound patients, increasing their morbidity, mortality, and pain distress. The challenge is to treat wounds effectively and prevent their deterioration. Multiple new wound products are released into the market yearly. The selection of appropriate products is hindered by numerous factors.
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